Pulmonary embolism and infarction

Case contributed by Ibrahim M. Jubarah
Diagnosis almost certain

Presentation

General fatigue, lower chest and upper abdominal pain, and dyspnea.

Patient Data

Age: 70 years
Gender: Female

Multiple contrast media filling defects in the left upper and lower main lobar arteries, and in multiple right and left segmental branches.

Peripherally consolidative areas in both lungs with their supplying arteries are showing contrast filling defects, along with being:

  • the consolidation in the right lower lobe showing variable postcontrast attenuation, with internal air lucencies (bubbly consolidation and suspected cavitation)
  • the consolidation in the superior segment of the left lower lobe.is wedge-shaped

The heart appears enlarged.

The visualized aorta appears unremarkable apart from calcified atheromatous plaques.

Dilated intrahepatic biliary tree, and a lobulated cystic lesion in right hepatic lobe, are noted.

Case Discussion

Multiple bilateral pulmonary emboli and infarcted areas of lung.

In this case, the consolidations are favored to be considered infarctions by:

  • consolidative-supplying artery thromboembolism (in both lungs)
  • postcontrast hypoattenuating lung parenchyma with small air foci (bubble consolidation) and suspected cavitation (in the right lung)
  • peripherally wedge-shaped consolidation (in the left lung)

The cystic lesion in the liver could be a simple cyst or biloma, and the intrahepatic biliary dilatation should be further evaluated as well as searching for the cause of the pulmonary emboli.

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