Which CT features are helpful in establishing the reason for his chest pain and haemoptysis?
Feeding vessel with occlusion. Pleurally based non-enhancing convex lung opacity with lower central attenuation.
Filling defect in subsegmental feeding pulmonary artery with distal pleurally-based convex non-enhancing lung opacity demonstrating a thin dense rim and lower central attenuation with no air bronchograms, typical of haemorrhagic infarction. Subtle regional ground glass opacity is compatible with blood in air spaces. The right pleural collection has higher attenuation compatible with haemorrhage.
4 chamber dilatation and contrast medium reflux into the IVC and hepatic veins due to heart failure. Pacemaker for heart block.