Acute Mitral Valve Regurgitation Presenting With Right Upper Lobe Opacification.

There is literature describing unilateral or focal pulmonary edema due to mitral regurgitation. The proposed mechanism is a regurgitant jet propelling blood towards the orifice of a particular pulmonary vein within the left atrium, which selectively pressurizes that vein. The increased hydrostatic pressure is transmitted to the pulmonary capillaries that drain into that vein, causing focal consolidation. A 62-year-old female presented with acute hypoxic respiratory failure. Her dyspnea started suddenly and she was unresponsive when she arrived at the emergency department via emergency medical services. Her initial oxygen saturation was 23% and she was immediately intubated. Sequential chest radiographs demonstrated dense consolidation in the right upper lung field and then opacification of the right hemithorax. These asymmetric lung findings were suspicious for infectious etiology but she was afebrile with no respiratory secretions and had normal inflammatory markers. Echocardiography showed a ruptured anterior papillary muscle causing a flail mitral valve leaflet with severe mitral regurgitation. The patient developed cardiogenic shock; she had an intra-aortic balloon pump placed for afterload reduction and was taken to the operating room for an emergency mitral valve replacement. Her clinical status rapidly improved and she made a full recovery. As in this case, acute mitral regurgitation can present with sudden life-threatening respiratory failure and cardiogenic shock so prompt diagnosis is critical. This is often misdiagnosed as pneumonia or other respiratory illnesses. Awareness, early diagnosis, and treatment of this entity could provide significant morbidity and mortality benefits for patients.

Acute Stroke Presenting as Unilateral Lower Extremity Monochorea.

Stroke is a common condition that can present with a wide range of signs and symptoms based on the region of the brain experiencing impaired perfusion. As the diagnosis and treatment of acute strokes is frequently initiated in the emergency department (ED), early recognition by emergency providers is essential in providing patients with the best chance of recovery and symptom resolution while attempting to minimize the risk of disability. While lateralizing weakness, numbness, and speech changes are among the most common symptoms of a stroke, in rare cases, patients may present with subtle or atypical symptoms, necessitating a high index of suspicion as well as a thorough history and physical examination. We present a case of acute ischemic stroke presenting with isolated choreiform movement.