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Cureus Jun 2022Pulmonary cavitation is an atypical finding in COVID-19 patients. In this rare case report, a 63-year-old woman (35 days from COVID-19 symptom onset) presented to our...
Pulmonary cavitation is an atypical finding in COVID-19 patients. In this rare case report, a 63-year-old woman (35 days from COVID-19 symptom onset) presented to our emergency department with acute chest pain and shortness of breath. A chest X-ray established right-sided total pneumothorax, hence a tube thoracostomy was performed. Due to a persistent air leak, chest computed tomography was performed, which showed areas of lung consolidation and a cavitary mass in the upper lobe of the right lung. The woman undertook a thoracoscopy, which established multiple petechiae on the lung surface and a bronchopleural fistula of the right lung's upper lobe. The treatment of choice was an atypical lung resection to remove the necrotic cavitary lesion. Histological and microbiological examination of the resected lung specimen showed a bland (aseptic) cavitary pulmonary infarct. Pulmonary infarction is a rare cause of cavitation in COVID-19 patients, nonetheless, something that should be considered in those presenting with respiratory symptoms or complications during or post-COVID-19.
PubMed: 35923672
DOI: 10.7759/cureus.26464 -
The New England Journal of Medicine Jun 1977We compared 41 patients with angiographic proof of pulmonary embolism and clinical signs of pulmonary infarction (as evidenced by an infiltrate on x-ray study and...
We compared 41 patients with angiographic proof of pulmonary embolism and clinical signs of pulmonary infarction (as evidenced by an infiltrate on x-ray study and pleuritic pain in the area of the embolus) with 24 patients with pulmonary embolism but without infarction. Only 18 of the 41 patients with pulmonary infarction had associated heart disease. Pulmonary infarction was uncommon when emboli obstructed central arteries but frequent when distal arteries were occluded. Follow-up x-ray examination showed that the infiltrates resolved in the patients with pulmonary infarction without heart disease, but persisted when heart disease was present. We suggest that obstruction of distal arteries results in pulmonary hemorrhage owing to an influx of bronchial arterial blood at systemic pressure. Hemorrhage causes symptoms and x-ray changes usually attributed to pulmonary infarction. However, hemorrhage resolves without infarction in patients without, but progresses to infarction in those with, heart disease.
Topics: Angiography; Auscultation; Heart Diseases; Hemorrhage; Humans; Infarction; Lung; Lung Diseases; Models, Biological; Pulmonary Circulation; Pulmonary Embolism
PubMed: 865513
DOI: 10.1056/NEJM197706232962503 -
Chirurgia (Bucharest, Romania : 1990) 2019We present the case of a 49 years-old female treated 10 years ago for a breast cancer (mastectomy followed by radio- and chemotherapy), referred to our unit for a...
We present the case of a 49 years-old female treated 10 years ago for a breast cancer (mastectomy followed by radio- and chemotherapy), referred to our unit for a recurrent pleural effusion with no response to medical treatment (pleural liquid - total proteins 4,1 g%, glucose 100 mg%, LDH 493 U/l, abundant cellularity with 30% eosinophils but no obvious neoplastic cells). The CT examination showed a loculated pleural effusion and a thickened irregular pleura, raising the suspicion of malignancy. Intraoperatively we found a loculated effusion - Fraser Gourd decortication and 7 subpleural pulmonary tumors with a diameter between 0,5 and 5 cm which we considered to be pulmonary metastases and performed non-anatomical resections with pulmonary reconstruction. The postoperative course was favourable, with discharge on postoperative day 16.The pathologic examination showed an inflammatory infiltrated pleura with no atypia and pulmonary infarction in all the 7 pulmonary resection specimens. Standard coagulation tests were normal but a detailed analysis of the coagulation status was not available, while postoperative cardiac and peripheric venous ultrasound did not show any abnormality explaining the pulmonary infarction. After the definitive diagnosis, the patient was treated with antiaggregants and dicumarinic oral anticoagulation, the later being abandoned due to poor compliance. At the 26 months follow-up the patient showed no signs of recurrence but she died at 32 months after surgery due to a stroke. The case is interesting due to the illustration of the diagnostic difficulties encountered in the oncological patients with pleural effusions; considering this case as "inoperable" would have resulted in anuseless chemotherapy and progression towards a more severe pleuro-pulmonary suppuration.
Topics: Breast Neoplasms; Female; Humans; Mastectomy; Middle Aged; Pleural Effusion; Pulmonary Infarction; Treatment Outcome
PubMed: 31511140
DOI: 10.21614/chirurgia.114.4.502 -
Medicina Intensiva Oct 2022
Topics: Humans; Lung; Pulmonary Embolism; Pulmonary Infarction
PubMed: 35872081
DOI: 10.1016/j.medine.2022.06.015 -
BMJ Open Dec 2022Pulmonary infarction is a common clinical and radiographic finding in acute pulmonary embolism (PE), yet the clinical relevance and prognostic significance of pulmonary... (Observational Study)
Observational Study
OBJECTIVE
Pulmonary infarction is a common clinical and radiographic finding in acute pulmonary embolism (PE), yet the clinical relevance and prognostic significance of pulmonary infarction remain unclear. The study aims to investigate the clinical features, radiographic characteristics, impact of reperfusion therapy and outcomes of patients with pulmonary infarction.
DESIGN, SETTING AND PARTICIPANTS
A retrospective cohort study of 496 adult patients (≥18 years of age) diagnosed with PE who were evaluated by the PE response team at a tertiary academic referral centre in the USA. We collected baseline characteristics, laboratory, radiographic and outcome data. Statistical analysis was performed by Student's t-test, Mann-Whitney U test, Fischer's exact or χ test where appropriate. Multivariate logistic regression was used to evaluate potential risk factors for pulmonary infarction.
RESULTS
We identified 143 (29%) cases of pulmonary infarction in 496 patients with PE. Patients with infarction were significantly younger (52±15.9 vs 61±16.6 years, p<0.001) and with fewer comorbidities. Most infarctions occurred in the lower lobes (60%) and involved a single lobe (64%). The presence of right ventricular (RV) strain on CT imaging was significantly more common in patients with infarction (21% vs 14%, p=0.031). There was no significant difference in advanced reperfusion therapy, in-hospital mortality, length of stay and readmissions between groups. In multivariate analysis, age and evidence of RV strain on CT and haemoptysis increased the risk of infarction.
CONCLUSIONS
Radiographic evidence of pulmonary infarction was demonstrated in nearly one-third of patients with acute PE. There was no difference in the rate of reperfusion therapies and the presence of infarction did not correlate with poorer outcomes.
Topics: Adult; Humans; Pulmonary Infarction; Retrospective Studies; Pulmonary Embolism; Lung; Risk Factors; Acute Disease; Ventricular Dysfunction, Right
PubMed: 36581412
DOI: 10.1136/bmjopen-2022-067579 -
Seminars in Thrombosis and Hemostasis Nov 2016Pulmonary infarction occurs in nearly one-third of the patients with acute pulmonary embolism. Infarcts are still often mistaken for pneumonia or lung cancer because of...
Pulmonary infarction occurs in nearly one-third of the patients with acute pulmonary embolism. Infarcts are still often mistaken for pneumonia or lung cancer because of the deeply rooted belief that they ought to be triangular in shape. In reality, the apical portion of an embolized region is spared from infarction thanks to sufficient collateral blood flow. Infarcts are always arranged peripherally along the surface of the visceral pleura (costal, diaphragmatic, mediastinal, or interlobar). Their free margin is sharp and convex toward the hilum, casting a semicircular or cushion-like density on chest radiography or computed tomography (CT). Focal areas of hyperlucency within the infarction are often seen on CT. Clinical presentation is nonspecific. Pleuritic chest pain, either isolated or in combination with abrupt dyspnea, is the most frequent presenting symptom, whereas hemoptysis is much rarer. Recent data indicate that younger age, increasing body height, and active cigarette smoking are independent predictors of infarction in the setting of acute pulmonary embolism. Correct recognition of pulmonary infarction is fundamental because pleural-based consolidations suggestive of infarction may be the first manifestation of pulmonary embolism.
Topics: Humans; Male; Middle Aged; Pulmonary Infarction; Risk Factors
PubMed: 27743556
DOI: 10.1055/s-0036-1592310 -
Journal of Thoracic Imaging Mar 2006Despite the dual blood supply to the lung, acute pulmonary embolism (PE) can lead to a spectrum of ischemic injury to the lung resulting in infarction and hemorrhage. In...
OBJECTIVE
Despite the dual blood supply to the lung, acute pulmonary embolism (PE) can lead to a spectrum of ischemic injury to the lung resulting in infarction and hemorrhage. In this series we systematically describe the spectrum of CT findings and clinical correlates of pulmonary infarction in patients with PE.
METHODS
We retrospectively identified 24 consecutive adults with pulmonary infarction on multidetector CT between July 2002 and March 2004. There were 13 women and 11 men, with a mean age of 59 years. The cases were identified by review of 74 consecutive CTs demonstrating PE. Each CT was evaluated by 2 of 3 reviewers in consensus for presence and characteristics of peripheral parenchymal opacities and extent of PE. Peripheral opacities were evaluated for degree of enhancement, internal air lucencies, and contour. The presence of adjacent vessels and linear strands were noted. At the end of interpreting each case, the reviewers determined whether or not an infarct was present based on the constellation of previously described imaging features. The extent of pulmonary vascular obstruction was graded using the CT clot burden scoring system. Each chart was reviewed for predisposing factors for PE and infarction, presenting clinical symptoms/signs, and co-existing pulmonary or cardiac conditions.
RESULTS
Thirty-two percent (24/74) of patients with PE had pulmonary infarction. Thirty-three percent (8/24) of patients had more than 1 infarct. Seventy-three percent (27/37) of infarcts were in the lower lobes. The CT findings of pulmonary infarction included: focal decrease in parenchymal enhancement in 95% (35/37), broad pleural base in 65% (24/37), truncated apex in 57% (21/37), convex border in 46% (17/37), internal air lucencies in 32% (12/37), linear stranding from the apex toward the hilum in 24% (9/37), and a thickened vessel leading to the apex of the infarct in 14% (5/37). There was a trend toward a higher mean clot burden (12.3 vs. 10.5) between the patients with PE with and without infarction. Ninety-six percent (23/24) of patients with pulmonary infarction had predisposing factors for infarction, including PE involving more than 1 lobe (n = 21), malignancy (n = 5), and heart failure (n = 3). Pleuritic chest pain was significantly more frequent in patients with infarction (P = 0.0064).
CONCLUSION
Pulmonary infarction occurred in nearly 1/3 of patients with PE in this series. The infarcts were peripheral parenchymal opacities characterized by a distinctive complex of findings on CT reflecting ischemic injury in the setting of a dual blood supply to the lung. Pleuritic chest pain was significantly associated with infarction.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Lung; Male; Middle Aged; Observer Variation; Pulmonary Embolism; Retrospective Studies; Tomography, Spiral Computed
PubMed: 16538148
DOI: 10.1097/01.rti.0000187433.06762.fb -
Respiratory Medicine Case Reports 2020A 25-year-old Chinese man visited our institution due to fever and left chest pain. A chest CT showed infiltrative shadows with pleural effusion. Despite antibiotics...
A 25-year-old Chinese man visited our institution due to fever and left chest pain. A chest CT showed infiltrative shadows with pleural effusion. Despite antibiotics treatment, his symptoms gradually worsened. The contrast CT showed deterioration of infiltrative shadows with thromboembolism in pulmonary arteries, suggesting pulmonary infarction. Thereafter, his HIV test turned out to be positive. His symptoms and radiological findings improved after initiation of an anticoagulant therapy. No known risk factors for thromboembolism were identified except HIV infection. The possibility of pulmonary thrombosis should be noted when the HIV patient with acute chest pain and pneumonia-like infiltrative shadow is seen.
PubMed: 33251107
DOI: 10.1016/j.rmcr.2020.101293 -
Asian Cardiovascular & Thoracic Annals Jun 2018Background Lung infarction is a rare complication of lung resection, developing mainly because of technical errors. In some cases, a specific reason cannot be...
Background Lung infarction is a rare complication of lung resection, developing mainly because of technical errors. In some cases, a specific reason cannot be identified. This study aimed to investigate the occurrence, characteristics, and outcome of this pathology in a series of patients. Methods The medical records of patients who underwent reoperation for lung infarction without an apparent cause (based on imaging, reoperation findings, and histopathology) after major lung resection at our institution from 2006 to 2015, were investigated. Results Seven patients were identified. The mean age was 62.2 years (range 51-75 years), and 5 were male. Copious dissection or adverse events during surgery were recorded in all but 2 cases. The main presenting symptom was unsettling frank hemoptysis (4 cases) with a variable time of onset of symptoms (4-164 h). All reoperations necessitated further lung resection (4 patients had a further lobectomy and 3 had a completion pneumonectomy). During reoperation, all vessels and bronchi were intact. No apparent cause of infarction could be identified according to the histopathology report. Morbidity after reoperation was atrial fibrillation in 3 cases and bronchopleural fistula in 2, one of which required a transsternal pneumonectomy and this was the only mortality. Length of stay ranged from 8 to 90 days. Conclusion Ipsilateral lung infarction after lobectomy is a rare complication and the reason may not be identifiable. Treatment usually requires reoperation. Extensive manipulation or adverse events during surgery could induce this rare complication.
Topics: Aged; Biopsy; Databases, Factual; England; Female; Hemoptysis; Humans; Infarction; Length of Stay; Lung; Male; Middle Aged; Pneumonectomy; Postoperative Hemorrhage; Reoperation; Retrospective Studies; Risk Factors; Time Factors; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29734831
DOI: 10.1177/0218492318776144 -
Oxford Medical Case Reports Dec 2022Takayasu arteritis (TAK) is a vasculitis that causes inflammation in the arterial walls of large blood vessels. The complication rate of pulmonary artery lesion in TAK...
Takayasu arteritis (TAK) is a vasculitis that causes inflammation in the arterial walls of large blood vessels. The complication rate of pulmonary artery lesion in TAK has been reported to be relatively high. Severe pulmonary artery stenosis can cause pulmonary infarction in rare cases. A 48-year-old woman had experienced cough and fever persistently for 3 months and visited a city hospital. Contrast-enhanced computed tomography (CT) and positron emission tomography (PET)-CT scans revealed TAK complicated with left pulmonary artery lesion. Contrast-enhanced CT couldn't detect wall thickening in the left smaller bifurcated pulmonary artery branch, but PET-CT did reveal this inflammation. Several weeks after we initiated treatment with high-dose prednisolone, the patient's symptoms and inflammatory findings disappeared. PET-CT may be useful for evaluating the inflammation of the pulmonary artery in TAK, and high-dose steroid monotherapy as induction therapy may be effective for TAK complicated with pulmonary artery lesions causing pulmonary infarction.
PubMed: 36540845
DOI: 10.1093/omcr/omac140