Pulmonary infarction

Case contributed by Dr Krister Askaner

Diagnosis certain

Presentation

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

Patient Data

Age: 72

Gender: Male

From the case: Pulmonary infarction

X-ray

Frontal

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.

From the case: Pulmonary infarction

Nine days later

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Axial C+ CTPA

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.