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Abstract: TH-PO195

Unilateral Pulmonary Edema in Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Varma, Prem P., Venkateshwar Hospital, Delhi, Delhi, India
  • Bajpai, Geet, Venkateshwar Hospital, Delhi, Delhi, India
  • Varma, Elly, Banner University Medical Center, University of Arizona, Tucson, Tucson, Arizona, United States
Introduction

Unilateral pulmonary edema (UPE) usually affects right upper lobe & is seen in less than 2% cases of cardiac failure.Severe mitral regurgitation (MR) is the commonest underlying cause.We report 4 cases of UPE in Hemo dialysis (HD) patients which resolved following dialysis.

Case Description

Four cases of Diabetic Nephropathy on MHD, presented with breathlessness.There was no preceding H/O chest pain/fever/hemoptysis.ECHO showed moderate MR in 2,mild & severe MR in one each.All had hypoalbuminemia (2.8-3.6 gm/dl).In view of Unilateral opacities on chest X-ray (Fig 1-4),patients were started on broad spectrum antibiotics.Following dialysis surprisingly there was clearance of opactites in all of them.(Fig 5-8 )

Discussion

UPE is a rare manifestation of cardiogenic pulmonary edema.Severe MR associated regurgitant blood in right pulmonary vein, poor lymphatic drainage of the right lung & hypoalbuminemia are the main contributing factors.

Our cases show that UPE can affect any zone of right lung..We feel that, in fluid overloaded dialysis patients even mild/moderate MR is enough to cause UPE of any zone.High index of suspicion for UPE and impressive clinical response following dialysis warrants repeat chest skiagram. Clearance on X-ray gives diagnosis avoids antibiotic therapy.

FIG 1-4 (X-ray at presentation of 4 cases)

FIG 5-8 (Post dialysis X-rays)