Pulmonary infarction

Case contributed by Dr Krister Askaner

Presentation

COPD and CHF (EF 25 %). Dyspnoe and bilateral lower leg edema. Elevated CRP and WBC.

Patient Data

Age: 72
Gender: Male
Modality: X-ray

Wedge-shaped opacities in the right midle and lower lobes. Small opacification in lower part of left upper lobe. 

Request for CT due to persistent symptoms despite adequate treatment. Haemoptysis. 
Referring physician asks for malignancy and/or pneumonia.

Nine days later

Modality: CT

Bilateral pulmonary embolism to middle, right lower  and left upper lobe arteries. Right atrial dilation. Wedge-shaped "bubbly" opacities due to pulmonary infarction.

Case Discussion

Lobar opacities may be non-specific but in this case with elevated CRP and WBC likely to be interpreted as pneumonia on the plain film study.

In acute pulmonary embolism it is more likely to not see any opacities in the lung parenchyma. 

CT examination above was performed in arterial phase because of the question of malignancy and/or pneumonia. Luckily there were good contrast enhancement in the pulmonary arteries which was crucial to achieve correct diagnosis.

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Case Information

rID: 48232
Case created: 26th Sep 2016
Last edited: 30th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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