Pulmonary parenchymal manifestations of mitral valve disease

Pulmonary parenchymal manifestations of mitral valve disease are the result of either pulmonary venous hypertension in mitral stenosis or abnormal reg urgitant flow into pulmonary veins in mitral insufficiency. Typical radiogr aphic findings in mitral stenosis include pulmonary vascular cephalization; interstitial, perivascular, and occasionally alveolar pulmonary edema; dif fuse alveolar hemorrhage, hemosiderosis; and pulmonary ossification. Signs of interstitial pulmonary edema are frequently visible and include septal l ines. Radiographic findings in diffuse alveolar hemorrhage consist of diffu se, confluent acinar or ground-glass areas of increased opacity, often spar ing the peripheral parenchyma and creating the so-called window frame effec t. Hemosiderosis is characterized by small, ill-defined nodules or by coars e reticular areas of increased opacity with a bias for the middle and lower lung regions. Ossification manifests as densely calcified, 1-5-mm nodules, mainly in the middle and lower lungs, with a tendency for confluence and t he occasional presence of trabeculae. Imaging findings in mitral regurgitat ion depend on the acuteness of the disease. The most common parenchymal man ifestations of acute mitral regurgitation are symmetric alveolar and inters titial pulmonary edema with indistinct, engorged pulmonary vessels and ceph alized blood flow. Familiarity with these manifestations can expedite diagn osis, particularly in rare cases of unsuspected mitral valve disease.