Case of the Week: Pulmonary Infarction (X-ray & CT)

In this radiology lecture, we discuss the chest x-ray and CT appearance of pulmonary infarction in the setting of acute pulmonary embolism.

Key points include:
1) Uncommon complication of pulmonary embolism.
2) Most common in right lung.
3) Risk of infarction increases with large clot burden.
4) Typically wedge-shaped, peripheral consolidation with no air bronchograms (Hampton hump).
5) However, may not be wedge-shaped, and not all wedge-shaped opacities will be infarcts in the setting of pulmonary embolism.
6) “Bubbly” consolidation containing rounded, central lucencies: Most specific finding of infarct* and represents a combination of infarcted, necrotic lung and adjacent viable, aerated lung.
7) “Vessel” sign: Enlarged vessel leading to apex of a wedge-shaped opacity. Vessel is dilated due to the presence of intraluminal thrombus or distal obstruction.

*Revel MP, Triki R, Chatellier G, et al. Is It possible to recognize pulmonary infarction on multisection CT images? Radiology. 2007;244(3):875-882.

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