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Clinical Images

Unusual Opacity

Dr. Davin Prasetyo
November 21, 2014

An 81year-old female presented with a dry cough. She had end-stage renal disease (ESRD). She was treated with IV antibiotics for presumed atypical pneumonia. Initial chest X-ray showed mild pulmonary congestion and increased opacity in the left lung base likely due to cardiomegaly, atelectasis and pleural fluid. Subsequently she had episodes of typical chest pain with lateral T wave inversion on ECG without a rise in troponin. Furthermore, she developed episodes of acute pulmonary edema requiring non-invasive ventilation. Repeat chest X-ray (fig.1) showed air opacity centrally within the right lung and a left pleural effusion. Transthoracic echocardiogram showed severe mitral regurgitation with associated systolic flow reversal in the right pulmonary vein.  


Figure 1

Figure 2

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1. Attias D. et al. Prevalence, characteristics, and outcomes of patients presenting with cardiogenic unilateral pulmonary edema. Circulation. 122(11):1109-15, 2010 Sep 14

Dr. Davin Prasetyo is currently working as a medical registrar in South Western Sydney Local Health District, Australia. He is specializing in internal medicine and his main interest is in teaching.