Etiology of Multiple Pulmonary Nodules: Mitral Stenosis

A 36-year-old male patient, with a history of mitral valve replacement (MVR) operation eight years prior, was admitted with chest pain. A physical examination revealed no pathologies except swelling, redness, and sensitivity on the site of the scar tissue of a sternotomy. Bilateral nodular densities were detected in the chest X-ray. Computed tomography of the thorax revealed calcification at the site of the mitral valve and randomly distributed, multiple millimetric pulmonary nodules, some of which were calcified. Underlying infectious, granulomatous, or neoplastic pathologies were not detected upon further evaluation, and the nodules were accepted as secondary to mitral valve stenosis. Chest pain was due to sternal wire sutures and was completely resolved after removal of the sutures. Patient was readmitted with hemoptysis and severe chest pain 16 months after the first admission. Cardiac evaluation revealed that hemoptysis and the pulmonary nodules were caused by pulmonary congestion together with increases in the left atrial pressure, due to ineffective warfarin treatment after the MVR operation. Rheumatic heart diseases should be a part of the differential diagnosis in researching the etiology of pulmonary nodules, as they continue to be encountered frequently in Turkey.