Pulmonary infarction (PI), defined as localized destruction (necrosis) of lung tissue due to obstruction of the arterial blood supply by an embolus, is a rare condition because of the dual blood supply of the lungs. It occurs more in elderly patients who typically have associated co-morbidities, such as chronic heart and lung disease, which affect blood circulation. Pulmonary infarction may present with chest pain, fast breathing, blood tinged cough and fever, resembling more common conditions such as bacterial pneumonia and tuberculosis. High index of suspicion is required for early diagnosis of this condition as mortality from this condition can be as high as 70%. We present a case of cavitary pulmonary infarction in a middle-aged female with no major risk factors for pulmonary embolism who was initially managed as a case of pulmonary tuberculosis. The clinical presentation, pathogenesis, imaging findings and management of PI have also been discussed. The purpose of this report is to increase the awareness of this less common condition among clinicians and highlight the radiologic differences between PI and the more common inflammatory diseases of the lung.
References
[1]
Dahnert, W. (2011) Radiology Review Manual. 7th Edition, Lippincott Williams & Wilkins, Philadelphia, 495.
[2]
Libby, L.S., King, T.E., LaForce, F.M. and Schwarz, M.I. (1985) Pulmonary Cavitation Following Pulmonary Infarction. Medicine (Baltimore), 64, 342-348. https://doi.org/10.1097/00005792-198509000-00006
[3]
Butler, M.D., Biscardi, F.H., Schain, D.C., Humphries, J.E., Blow, O., et al. (1997) Pulmonary Resection for Treatment of Cavitory Pulmonary Infarction. The Annals of Thoracic Surgery, 63, 849-850. https://doi.org/10.1016/S0003-4975(96)01253-2
[4]
Morgenthaler, T.I., Ryu, J.H. and Utz, J.P. (1995) Cavitary Pulmonary Infarct in Immune-Compromised Hosts. Mayo Clinic Proceedings, 70, 66-68. https://doi.org/10.4065/70.1.66
[5]
Koroscil, M.T. and Hauser, T.R. (2016) Acute Pulmonary Embolism Leading to Cavitation and Large Pulmonary Abscess: A Rare Complication of Pulmonary Infarction. Respiratory Medicine Case Reports, 20, 72-74. https://doi.org/10.1016/j.rmcr.2016.12.001
Wang, P.W., Kuo, P.H., Chang, Y.C. and Yang, P.C. (2002) A Patient with Right Upper Quadrant Abdominal Pain, Hypotension and Dyspnoea. European Respiratory Journal, 20, 238-241. https://doi.org/10.1183/09031936.02.00300502
[8]
Djordjevic, I., Pejcic, T., Rancic, M., Radovic, M., Bosnjakovic, P., et al. (2009) Difficulties in Establishing a Timely Diagnosis of Pulmonary Artery Sarcoma Misdiagnosed as Chronic Thrombo-Embolic Pulmonary Disease: A Case Report. Journal of Medical Case Reports, 3, 64. https://doi.org/10.1186/1752-1947-3-64
[9]
Herbert, L. (1969) Fred Bacterial Pneumonia or Pulmonary Infarction? Chest, 55, 422-425. https://doi.org/10.1378/chest.55.5.422
[10]
Webb, W.R. and Higgins, C.B. (2010) Thoracic Imaging: Pulmonary and Cardiovascular Radiology. 2nd Edition, Lippincott Williams & Wilkins, Philadelphia, 117.
[11]
Stein, P.D., Woodard, P.K., Weg, J.G., Wakefield, T.W., Tapson, V.F., et al. (2007) Diagnostic Pathways in Acute Pulmonary Embolism: Recommendations of the PIOPED II Investigators. Radiology, 242, 15-21. https://doi.org/10.1148/radiol.2421060971
[12]
Patel, S. and Kazerooni, E.A. (2005) Helical CT for the Evaluation of Acute Pulmonary Embolism. The American Journal of Roentgenology, 185, 135-149. https://doi.org/10.2214/ajr.185.1.01850135
[13]
Revel, M., Triki, R., Chatellier, G., Couchon, S., Haddad, N., et al. (2007) Is It Possible to Recognize Pulmonary Infarction on Multisection CT Images? Radiology, 244, 875-882. https://doi.org/10.1148/radiol.2443060846
[14]
Wilson, A.G., Joseph, A.E.A. and Butland, R.J.A. (1986) The Radiology of Aseptic Cavitary Pulmonary Infarction. Clinical Radiology, 37, 327-333. https://doi.org/10.1016/S0009-9260(86)80263-X
[15]
Piazza, G., Hohlfelder, B., Jaff, M.R., et al. (2015) A Prospective, Single-Arm, Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism. JACC: Cardiovascular Interventions, 8, 1382-1392. https://doi.org/10.1016/j.jcin.2015.04.020
[16]
Marchiori, E., Zanetti, G., Meirelles, G.S., Escuisatto, G.L., Souza, A.S., et al. (2011) The Reversed Halo Sign on High Resolution CT in Infectious and Non-Infectious Pulmonary Diseases. The American Journal of Roentgenology, 197, 69-75. https://doi.org/10.2214/AJR.10.5762
[17]
Miniati, M. (2016) Pulmonary Infarction: An Often Unrecognized Clinical Entity. Seminars in Thrombosis and Hemostasis, 42, 865-869. https://doi.org/10.1055/s-0036-1592310
