102 Prevalence, characteristics and outcomes of patients presenting with cardiogenic unilateral pulmonary edema

Abstract

Cardiogenic unilateral pulmonary oedema (UPE) is rare and often misdiagnosed. The aim of our study was to determine the prevalence of UPE; the clinical characteristics and the outcomes of this particular form of cardiogenic pulmonary oedema. A retrospective study that enrolled all consecutive patients admitted in the two intensive care units of a French University Hospital for cardiogenic pulmonary oedema from January 2000 to may 2008. 869 consecutive patients (475 men, 394 women; mean age 75.4 +/- 13.0 were hospitalized during this period. Among this population, 18 patients (10 men, 8 women; mean age 76.4 +/- 12.9, range 46 to 94 years) presented with radiological features of unilateral pulmonary edema resulting in a prevalence of 2%. UPE was right-sided in 16 cases and left-sided in 2. UPE was associated in all cases with a severe mitral regurgitation (MR). 53 additional patients presented a bilateral pulmonary edema (BPE) associated with severe MR. Clinical and echocardiographic features were similar between patients with UPE or BPE due to severe MR. However, patients with UPE required significantly more use of non-invasive or invasive ventilation (p= 0.008) and catecholamines (p = 0.01) than patients with classical BPE due to severe MR. Use of antibiotherapy was significantly higher in patients with UPE than in patients with BPE associated with severe MR (11/18 Vs 3/53, p < 0.0001). Mortality was significantly higher in patients with UPE (39%) than in patients with BPE (6%) due to severe MR in univariate analysis [OR=10.6, (95% CI : 2.4 – 47), p=0.0021] and in multivariate analysis [OR=8.4, (95% CI : 1.5 – 47), p=0.015]. In our study, unilateral pulmonary oedema represents 2% of all cardiogenic pulmonary edema and usually appears as an opacity involving the right upper lobe. Because of the risk of misdiagnosis (pneumonia, neoplasm), UPE has to be known to avoid delays in treatment that may affect prognosis.