Case 1.
Female,
66 years old
Personal history of Diabetes Mellitus 2,
arterial hypertension,
Chronic occlusive arterial disease.
She is admitted for marked dyspnea and generalized edema.
Admission Diagnosis: Decompensated Heart Failure - Pulmonary Edema.
Echocardiography: Mixed Cardiopathy (Ischemic and Severe Mitral Valvulopathy) with LVEF25%.
Fig. 2: Chest X-ray: Bilateral alveolar opacities of right predominance
The patient presents important clinical deterioration,
with increased dyspnea and oxygen support requirement at high flow.
With well score of 3,
Thorax CT angiography is ordered due to suspicion of pulmonary embolism.
Fig. 3: Thorax angioTC: Negative study for PE, alveolar opacities in both predominantly right fields.
Evolution
Coronariography: did not show significant injuries.
Echocardiography: Severe mitral failure due to rupture of the chordae tendineae.
Order heart failure management.
Fig. 4: Chest X-ray: control after 2 days, improvement of parenchymal opacities.
It is scheduled for cardiac surgery.
She dies due to hemodynamic instability.
Case 2.
Female,
74 years old.
Personal history: Diabetes mellitus,
hypertension,
chronic kidney disease
She is admitted for suspicion of critical ischemia of the lower left limb which is discarded.
During the hospitalization,
she presents marked dyspnea and clinical deterioration.
Initial chest x-ray with findings suggestive of an infectious process,
antibiotic management is initiated.
Fig. 5: Chest X-ray: Bilateral alveolar opacities of right predominance -
cardiomegaly
Thorax tomography is requested for continuing respiratory deterioration despite management.
Fig. 6: Thoracic tomography: Central alveolar occupation with predominance in the right upper lobe associated with septal thickening.
Evolution:
Echocardiogram: Mixed cardiopathy: ischemia and valvular (severe mitral regurgitation).
Ejection fraction 29%.
The patient continues with deterioration,
she requires transfer to the intensive care unit.
They initiate management of cardiac failure
Order control RX
Fig. 7: Chest x-ray: 3 days later, improvement of parenchymal opacities with respect to previous studies
She has cardiogenic shock and dies
Case 3:
Male,
69 years old
Personal history of chronic kidney disease in hemodialysis,
hypertension and heart failure FE 14%.
I have consulted the emergency department for dyspnea and cough.
Chest x-ray ordered to rule out infectious process
Fig. 8: Chest x-ray: Mixed bilateral opacities of right predominance - cardiomegaly
Chest tomography: requested to confirm diagnosis and to rule out other causes of dyspnea
Fig. 9: Chest tomography: Alveolar occupation of right hemitorax with septal thickening.
Evolution
Patient with acute phase reactants in normal values.
Normal smear microscopy and PCR for mycobacteria negative.
They optimize the management of heart failure with clinical improvement and control x-rays
Fig. 10: Control chest radiography: improvement of parenchymal involvement when compared with previous study - cardiomegaly.
Case 4.
Patient of 80 years
History of congestive heart failure,
type 2 diabetes,
hypertension and chronic kidney disease.
He is admitted to the emergency department for dyspnea,
productive cough and edema in lower limbs.
Chest X ray is requested.
Fig. 11: Chest x-ray: bilateral pleural effusion, the left in abundant amount
Echocardiography: mixed heart disease with LVEF 25%.
Chest tomography: requested for clinical deterioration.
Fig. 12: Chest tomography: Cardiomegaly - Pericardial effusion - Bilateral pleural effusion of free distribution, the left in abundant quantity - Consolidation of the left air space with ground glass opacities.
Evolution
Reactants of acute phase without significant elevation.
They started management for congestive heart failure.
Subsequent clinical deterioration he dies due to ventilatory failure and cardiogenic shock.