Aseptic Cavitation in Pulmonary Infarction

Scharf, Joachim-Hermann; Nahir, A. M.; Munk, J.; Lichtig, C

doi:10.1378/chest.59.4.456

Cited by 19 publications

(6 citation statements)

References 3 publications

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“…1 Computed tomogram features of scalloped inner margins and cross-cavity band shadows have also been reported to favor cavitating pulmonary infarction. 1 Cavitation occurs earlier in an infected embolism (mean 18 d, range 6 -40 d) than in a bland infarct (mean 28 d, range 7-120 d). 5 Complications such as pneumothorax, empyema, and bronchopleural fistula have been reported in bland infarctions 6 but are more common in infected infarctions.…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnosis for pulmonary cavitation is broad (Table 1). Pulmonary infarction is a well recognized cause of cavitation 1 and accounted for about 1% of all non-tuberculous cavities in the pre-CT era. 2 Pulmonary infarction occurs in only 10% of pulmonary embolism, given the dual nature of pulmonary blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…4 Prominent fever and purulent sputum indicates super-added infection. 1,5 Radiograph features of constant cavity size, irregular cavity outline, and no fluid level may suggest a bland (ie, not infected) cavity. 1 Computed tomogram features of scalloped inner margins and cross-cavity band shadows have also been reported to favor cavitating pulmonary infarction.…”

Section: Discussionmentioning

confidence: 99%

“…1,5 Radiograph features of constant cavity size, irregular cavity outline, and no fluid level may suggest a bland (ie, not infected) cavity. 1 Computed tomogram features of scalloped inner margins and cross-cavity band shadows have also been reported to favor cavitating pulmonary infarction. 1 Cavitation occurs earlier in an infected embolism (mean 18 d, range 6 -40 d) than in a bland infarct (mean 28 d, range 7-120 d).…”

Section: Discussionmentioning

confidence: 99%

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Infected Cavitating Pulmonary Infarction

Srinivas

Devaraj

2011

Respir Care

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Infected Cavitating Pulmonary Infarction

Srinivas

Devaraj

2011

Respir Care

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“…4 These cavities are usually single and predominantly on the right side in the apical or posterior segment of the upper lobe or the apical segment of the right lower lobe, as in our patient. [5][6][7][8] CT demonstrating scalloped inner margins and cross-cavity band On thoracentesis, 1,000 mL of turbid sanguineous pleural fl uid was removed shadows suggests a cavitary pulmonary infarction. 9,10 Infection and abscess in pulmonary infarction are poorly understood but have been linked to larger infarctions, coexistent congestion or atelectasis, and dental or oropharyngeal infection.…”

Section: ■ How Does Pulmonary Infarction Present Clinically?mentioning

confidence: 99%

Pulmonary infarction due to pulmonary embolism

Sonmez

Aboussouan

Farver

et al. 2018

CCJM

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A 76-year-old man whose history included abdominal aortic aneurysm repair, bilateral femoral artery bypass for popliteal artery aneurysm, hypertension, and peptic ulcer disease was admitted to a community hospital with pleuritic chest pain and shortness of breath. Two days earlier, he had undergone repair of a ventral hernia.At the time of that admission, he reported no fever, chills, night sweats, cough, or history of heart or lung disease. His vital signs were normal, and physical examination had revealed no apparent respiratory distress, no jugular venous distention, normal heart sounds, and no pedal edema; however, decreased air entry was noted in the right lung base. Initial serum levels of troponin and Nterminal pro-B-type natriuretic peptide were normal.At that time, computed tomographic angiography of the chest showed segmental pulmonary emboli in the left upper and right lower lobes of the lungs and right pleural effusion. Transthoracic echocardiography showed normal atrial and ventricular sizes with no right or left ventricular systolic dysfunction and a left ventricular ejection fraction of 59%.Treatment with intravenous heparin was started, and the patient was transferred to our hospital. ■ PLEURAL EFFUSION AND PULMONARY EMBOLISM1 Which of the following is true about pleural effusion? □ It is rarely, if ever, associated with pulmonary embolism □ Most patients with pleural effusion due to pulmonary embolism do not have pleuritic chest pain □ Pulmonary embolism should be excluded in all cases of pleural effusion without a clear cause Pulmonary embolism should be excluded in all cases of pleural effusion that do not have a clear cause. As for the other answer choices: • Pulmonary embolism is the fourth leading cause of pleural effusion in the United States, after heart failure, pneumonia, and malignancy. 1 • About 75% of patients who develop pleural effusion in the setting of pulmonary embolism complain of pleuritic chest pain on the side of the effusion. 2 Most effusions are unilateral, small, and usually exudative. 3 ■ EVALUATION BEGINS: RESULTS OF THORACENTESISOur patient continued to receive intravenous heparin. He underwent thoracentesis on hospital day 3, and 1,000 mL of turbid sanguineous pleural fl uid was removed. Analysis of the fl uid showed pH 7.27, white blood cell count 3.797 × 10 9 /L with 80% neutrophils, and lactate dehydrogenase (LDH) concentration 736 U/L (a ratio of pleural fl uid LDH to a concurrent serum LDH > 0.6 is suggestive of an exudate); the fl uid was also sent for culture and cytology. Thoracentesis was terminated early due to cough, and follow-

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