Cavitating pulmonary infarction

Case contributed by Chris O'Donnell


Previous DVT, now short of breath and low oxygen saturation.

Patient Data

Age: 85 years
Gender: Male

CTPA on diagnosis


Irregular filling defect in the left main and upper lobe pulmonary artery with substantial lung collapse together with pleural effusion and consolidation in the left upper lobe with very early cavitation (air-fluid level).

1 week post PE diagnosis


Persistent filling defect in the left main pulmonary artery with improved aeration of the left lung (albeit with residual pleural effusion) and development of a large cavitating mass in the posterior segment of the left upper lobe.

5 months post PE diagnosis


Minor residual filling defect in the left main pulmonary artery with almost complete resolution of the cavitating mass in the left upper lobe (leaving minor lung fibrosis)

Case Discussion

This is an unusual case - consolidation is present at the site of pulmonary embolism representing pulmonary infarction with development of central cavitation that resolves over time with only minor residual cavity and fibrosis.  The embolus has not completely resolved over the 5 month period.  Findings fit the known history of such a pathological process i.e. it tends to be in the upper lobes of older patients (having poor cardiac function).  Cavitation develops centrally in the region of "dead lung" with eventual healing and scarring.

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