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Clinical Pearl: Consolidation on chest X-ray? Think UPE: Emergency Medicine News


A patient presenting to the ER with unilateral consolidation on chest x-ray would lead the physician to consider pneumonia as the likely etiology, especially in the current era of COVID-19. However, it is not widely recognized that cardiogenic pulmonary edema can present with one-sided consolidation (unilateral cardiogenic pulmonary edema). (Cleve Clin J Med. 2022;89[3]:124;; Traffic. 2010;122[11]:1109;

One study found that the prevalence of unilateral pulmonary edema was 2.1% among a large population of patients with cardiogenic pulmonary edema. (Traffic. 2010;122[11]:1109; It was always associated with severe mitral regurgitation and delay in initiating appropriate treatment was common. Mortality was found to be twice that of bilateral disease due to misdiagnosis early in the patient’s course.

Severe mitral insufficiency remains the main cause of unilateral pulmonary edema. The direction of mitral regurgitation towards the posterior wall of the left atrium selectively interferes with the right pulmonary venous system; regurgitant flow focally elevates pressure in the right pulmonary vein. (Cleve Clin J Med. 2022;89[3]:124;; Traffic. 2010;122[11]:1109;; Process [Bayl Univ Med Cent]. 2021;34[2]:289;

Remember unilateral pulmonary edema when evaluating a patient with unilateral consolidation. Absence of fever, sudden onset of dyspnea, history and level of brain natriuretic peptide can help differentiate it from other diagnoses. (Traffic. 2010;122[11]:1109; Mitral regurgitation murmur can be a helpful sign.

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