| Cavitating pulmonary infarction occurs in only 10% of patients of pulmonary thrombo-embolism. Patients with a pre-existing cardio-pulmonary disease are especially predisposed. Morphologically, the infarct is typically haemorrhagic with coagulative necrosis of the parenchyma, which heals with minimal fibrosis. Liquefaction usually follows septic thrombo-embolism, though bland thrombi have also been implicated.
Generally cavitation occurs when the infarct is more than 4cm in diameter. It chiefly involves the upper and middle zones of the lungs with only 20% involvement of the lower lobes.
Cavitation is believed to occur due to superimposed infection. It is a rare cause of pneumothorax.
IMAGES
Case 1: 82 year old woman with hypertensive cardiomyopathy and PE. Image 1: x-ray of thorax of presentation with a cavitating mass in LID (arrows). The second image demonstrates a more favourable outcome with antibiotic treatment than with heparinization. The morphological resolution was complete, however functionally there persisted a dyspnoea on minimal exertion.
Case 2: 76 year old male, with multiple morbidities admitted with haemoptysis. In image 3 a poorly defined condensation is appreciated in LSD. In image 4, a cut is shown of CT where the nature of the mass can be appreciated, with central liquefaction and hypodensity of the clot responsible for the infarction, in the interior of the pulmonary artery (arrow). The outcome with antibiotics and heparin was good
BIBLIOGRAPHY
Vaideeswar P. Cavitary pulmonary infarction--a rare cause of spontaneous pneumothorax. J Postgrad Med 1998;44:99-100
Libby LS, King TE, LaForce FM, Schwarz MI. Pulmonary cavitation following pulmonary infarction.Medicine (Baltimore). 1985 Sep;64(5):342-8
Author:
Juan I Pérez Calvo
Servicio de Medicina Interna
Hospital Clínico Universitario
Translation: Kelly
Watt |
