An unusual presentation of pulmonary embolism leading to infarction, cavitation, abscess formation and bronchopleural fistulation

Abstract

We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.

Lung cavitation due to COVID-19 pneumonia

“… 1 2 Lung cavitation following pulmonary embolism and infarction has been described previously in non-COVID-19 patients. 3 4 In our case, cavitation predominantly occurred in the left lung, whereas pulmonary emboli were primarily noticed in the right lung. The velocity of the development of multiple cavitary lesions in a few weeks was felt to be atypical for Mycobacterium tuberculosis or fungal infections such as aspergillosis and most likely related to complications from COVID-19 pneumonia.…”

Simultaneous Giant cavity pulmonary lesion and pneumothorax following COVID-19 pneumonia

“…Spontaneous pneumotorax can be a late evolution of COVID-19 pneumonia [14] , although a bilateral sudden onset was also described in a 50 year old male smoker with history of mandibular carcinoma [15] . Emphysema, giant bullae and pneumothorax with alveolar rupture can develop in COVID-19 patients as a result of high-flow O 2 support [12] .…”

Non-surgical management of an abrupt cavitation and large oval-shaped lung abscess secondary to acute thromboembolic pulmonary infarction: a case report

“…The most common infections are from gram-negative bacteria ( Escherichia coli , Pseudomonas aeruginosa, and Proteus ), which helps clinicians to choose appropriate antibiotics. 5…”