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Thrombosis Research Jun 2021Pulmonary infarction results from occlusion of the distal pulmonary arteries leading to ischemia, hemorrhage and ultimately necrosis of the lung parenchyma. It is most... (Review)
Review
Pulmonary infarction results from occlusion of the distal pulmonary arteries leading to ischemia, hemorrhage and ultimately necrosis of the lung parenchyma. It is most commonly caused by acute pulmonary embolism (PE), with a reported incidence of around 30%. Following an occlusion of the pulmonary artery, the bronchial arteries are recruited as primary source of perfusion of the pulmonary capillaries. The relatively higher blood pressure in the bronchial circulation causes an increase in the capillary blood flow, leading to extravasation of erythrocytes (i.e. alveolar hemorrhage). If this hemorrhage cannot be resorbed, it results in tissue necrosis and infarction. Different definitions of pulmonary infarction are used in literature (clinical, radiological and histological), although the diagnosis is nowadays mostly based on radiological characteristics. Notably, the infarcted area is only replaced by a fibrotic scar over a period of months. Hence and formally, the diagnosis of pulmonary infarction cannot be confirmed upon diagnosis of acute PE. Little is known of the impact and relevance of pulmonary infarction in acute PE, and whether specific management strategies should be applied to prevent and/or treat complications such as pain, pneumonia or post-PE syndrome. In this review we will summarize current knowledge on the pathophysiology, epidemiology, diagnosis and prognosis of pulmonary infarction in the setting of acute PE. We highlight the need for dedicated studies to overcome the current knowledge gaps.
Topics: Acute Disease; Humans; Lung; Pulmonary Artery; Pulmonary Embolism; Pulmonary Infarction
PubMed: 33862471
DOI: 10.1016/j.thromres.2021.03.022 -
Journal of Clinical Medicine Aug 2022Pulmonary infarction (PI) is a possible consequence of pulmonary embolism (PE). The real incidence of PI could be underestimated considering only non-fatal PE... (Review)
Review
Pulmonary infarction (PI) is a possible consequence of pulmonary embolism (PE). The real incidence of PI could be underestimated considering only non-fatal PE presentation. However, following postmortem examination, the prevalence of PI is considerably higher. This evidence suggests the necessity of proper diagnostic protocol for identifying PI. Unfortunately, PI diagnosis can sometimes be challenging, due to the overlapping of symptoms with other diseases. Nowadays, the diagnosis is mainly based on radiological evaluation, although the combination with emerging imaging techniques such as ultrasound and nuclear scanning might improve the diagnostic algorithm for PI. This review aims to summarize the available data on the prevalence of PI, the main predisposing factors for the development of PI among patients with PE, to resume the possible diagnostic tools, and finally the clinical and prognostic implications.
PubMed: 36013155
DOI: 10.3390/jcm11164916 -
Portuguese Journal of Cardiac Thoracic... Jul 2022Pulmonary embolism (PE) is a potentially fatal disorder that occurs as a result of a thrombus formed in the deep venous system that detaches and obstructs the pulmonary... (Review)
Review
INTRODUCTION
Pulmonary embolism (PE) is a potentially fatal disorder that occurs as a result of a thrombus formed in the deep venous system that detaches and obstructs the pulmonary artery or one of its branches. Herein we report a rare, bilateral PE after surgical correction of the Achilles tendon.
OBJECTIVES
To report a bilateral PE after calcaneus tendon repair, and to review the literature on this rare condition.
MATERIALS AND METHODS
A search of the literature was carried out in electronic databases and a review of medical records.
CONCLUSION
PTE, although rare, is a serious and potentially fatal complication, requiring adequate and early treatment. Pharmacological prophylaxis in these situations is still controversial in the medical literature; however, there is consensus for the use of intermittent pneumatic compression in the postoperative period.
Topics: Achilles Tendon; Humans; Postoperative Complications; Pulmonary Embolism; Pulmonary Infarction; Plastic Surgery Procedures
PubMed: 35780410
DOI: 10.48729/pjctvs.280 -
European Journal of Radiology Dec 2014The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the... (Review)
Review
The impact of absent pulmonary arterial and venous flow on the pulmonary parenchyma depends on a host of factors. These include location of the occlusive insult, the speed at which the occlusion develops and the ability of the normal dual arterial supply to compensate through increased bronchial arterial flow. Pulmonary infarction occurs when oxygenation is cut off secondary to sudden occlusion with lack of recruitment of the dual supply arterial system. Thromboembolic disease is the commonest cause of such an insult but a whole range of disease processes intrinsic and extrinsic to the pulmonary arterial and venous lumen may also result in infarcts. Recognition of the presence of infarction can be challenging as imaging manifestations often differ from the classically described wedge shaped defect and a number of weighty causes need consideration. This review highlights aetiologies and imaging appearances of pulmonary infarction, utilising cases to illustrate the essential role of a multimodality imaging approach in order to arrive at the appropriate diagnosis.
Topics: Humans; Multimodal Imaging; Pulmonary Infarction
PubMed: 25241050
DOI: 10.1016/j.ejrad.2014.07.016 -
The Korean Journal of Internal Medicine Jul 2022
Topics: COVID-19; Hemoptysis; Humans; Pulmonary Artery; Pulmonary Infarction
PubMed: 35263839
DOI: 10.3904/kjim.2021.493 -
Thrombosis Research Jun 2023Pulmonary infarction (PI) is relatively common in pulmonary embolism (PE). The association between PI and persistent symptoms or adverse events is largely unknown.
BACKGROUND
Pulmonary infarction (PI) is relatively common in pulmonary embolism (PE). The association between PI and persistent symptoms or adverse events is largely unknown.
AIM
To evaluate the predictive value of radiological PI signs at acute PE diagnosis on 3-month outcomes.
METHODS
We studied a convenience cohort with computed tomography pulmonary angiography (CTPA)-confirmed PE for whom extensive 3-month follow-up data were available. The CTPAs were re-evaluated for signs of suspected PI. Associations with presenting symptoms, adverse events (recurrent thrombosis, PE-related readmission and mortality) and self-reported persistent symptoms (dyspnea, pain and post-PE functional impairment) at 3-month follow-up were investigated using univariate Cox regression analysis.
RESULTS
At re-evaluation of the CTPAs, 57 of 99 patients (58 %) had suspected PI, comprising a median of 1 % (IQR 1-3) of total lung parenchyma. Patients with suspected PI more often presented with hemoptysis (11 % vs. 0 %) and pleural pain (OR 2.7, 95%CI 1.2-6.2), and with more proximal PE on CTPA (OR 1.6, 95%CI 1.1-2.4) than patients without suspected PI. There was no association with adverse events, persistent dyspnea or pain at 3-month follow-up, but signs of PI predicted more functional impairment (OR 3.03, 95%CI 1.01-9.13). Sensitivity analysis with the largest infarctions (upper tertile of infarction volume) yielded similar results.
CONCLUSIONS
PE patients radiologically suspected of PI had a different clinical presentation than patients without those signs and reported more functional limitations after 3 months of follow-up, a finding that could guide patient counselling.
Topics: Humans; Pulmonary Infarction; Computed Tomography Angiography; Pulmonary Embolism; Pulmonary Artery; Dyspnea
PubMed: 37121011
DOI: 10.1016/j.thromres.2023.04.005 -
Pathology International Jul 2021Sarcoidosis is a systemic granulomatous disease. In pulmonary sarcoidosis, granulomatous vascular involvement is a common feature that occurs in all types of vessels,...
Sarcoidosis is a systemic granulomatous disease. In pulmonary sarcoidosis, granulomatous vascular involvement is a common feature that occurs in all types of vessels, including large elastic arteries to venules, but sarcoidosis complicated with pulmonary infarction has not been reported. We report a case of a 60 years old female, who was operated on a clinical diagnosis of lung cancer, and histological examination revealed a pulmonary infarction and sarcoidosis. In the pulmonary elastic arteries, granulomas infiltrated the adventitia and media, and caused elastic fiber collapse and destruction. Arterial occlusion by granulomas was observed in the edge of the infarcted area. It was considered that the arterial sarcoidosis granuloma involvement was the cause of pulmonary infarction. Sarcoidosis is a significant risk factor for cardiovascular events. However, pulmonary infarction is an extremely rare complication of sarcoidosis. Our case suggests that sarcoidosis may cause vascular events in the lungs.
Topics: Female; Granuloma; Humans; Lung; Lung Diseases; Lung Neoplasms; Middle Aged; Pulmonary Artery; Pulmonary Infarction; Sarcoidosis
PubMed: 33902154
DOI: 10.1111/pin.13104 -
The Pan African Medical Journal 2021Pulmonary infarction usually appears as a wedge-shaped opacity with its base placed laterally. Rarely, pulmonary infarctions may appear as a well-defined rounded opacity...
Pulmonary infarction usually appears as a wedge-shaped opacity with its base placed laterally. Rarely, pulmonary infarctions may appear as a well-defined rounded opacity mimicking lung cancer and surgical lung biopsy may often be required for definitive diagnosis. We report a patient who was admitted with submassive pulmonary embolism who had an incidental finding of a well-defined opacity in computed tomography (CT) scan. The lesion was avid on positron emission tomography (PET) scan and the patient was a smoker. So, we investigated him further with a percutaneous and later a thoracoscopic lung biopsy. Tumour-like pulmonary infarction is often a challenge for the clinicians.
Topics: Adult; Biopsy; Diagnosis, Differential; Humans; Lung Neoplasms; Male; Positron-Emission Tomography; Pulmonary Embolism; Pulmonary Infarction; Tomography, X-Ray Computed
PubMed: 33912297
DOI: 10.11604/pamj.2021.38.127.27595 -
Lancet (London, England) Oct 1951
Topics: Humans; Infarction; Lung; Pulmonary Infarction
PubMed: 14874505
DOI: No ID Found