Lung Infarction Following Pulmonary Embolism: A Comparative Study on Clinical Conditions and CT Findings to Identify Predisposing Factors

Abstract

Purpose: The aim of this study was to identify factors predisposing to lung infarction in patients with pulmonary embolism (PE). Materials and Methods: We performed a retrospective analysis on 154 patients with the final diagnosis of PE being examined between January 2009 and December 2012 by means of a Toshiba Aquilion 64 CT scanner. The severity of clinical symptoms was defined by means of a clinical index with 4 classes. The pulmonary clot load was quantified using a modified severity index of PE as proposed by Miller. We correlated several potential predictors of pulmonary infarction such as demographic data, pulmonary clot burden, distance of total vascular obstruction and pleura, the presence of cardiac congestion, signs of chronic bronchitis or emphysema with the occurrence of pulmonary infarction. Results: Computed tomography revealed 78 areas of pulmonary infarction in 45/154 (29.2?%) patients. The presence of infarction was significantly higher in the right lung than in the left lung (p?<?0.001). We found no correlation between pulmonary infarction and the presence of accompanying malignant diseases (r?=??0.069), signs of chronic bronchitis (r?=??0.109), cardiac congestion (r?=??0.076), the quantified clot burden score (r?=?0.176), and the severity of symptoms (r?=??0.024). Only a very weak negative correlation between the presence of infarction and age (r?=??0.199) was seen. However, we could demonstrate a moderate negative correlation between the distance of total vascular occlusion and the occurrence of infarction (r?=??0.504). Conclusion: Neither cardiac congestion nor the degree of pulmonary vascular obstruction are main factors predisposing to pulmonary infarction in patients with PE. It seems that a peripheral total vascular obstruction more often results in infarction than even massive central clot burden. Key points: ??A peripheral location of vascular occlusion is the main factor predisposing to pulmonary infarction. Citation Format: ??Kirchner J, Obermann A, St?ckradt S et?al. Lung Infarction Following Pulmonary Embolism: A Comparative Study on Clinical Conditions and CT Findings to Identify Predisposing Factors. Fortschr R?ntgenstr 2015; 187: 440???444

Lobectomy as a Complication of Pulmonary Infarct after Sub segmental Pulmonary Embolism

“…A recent retrospective comparative study by Kirchner et al evaluated possible causes for infarction with no correlation with cardiac congestion, malignancy, chronic bronchitis, clot burden, age or severity of symptoms. The main predisposing factor was peripheral location of vascular occlusion rather than large proximal occlusions [4]. This coincides with prior studies which showed the occlusion of pulmonary vessels smaller than 3 mm are likely beyond the physiologic anastomosis of the pulmonary and bronchial arteries and are thus predisposed to ischemia and infarction [5,6].…”

Infected pulmonary infarction. Case report

“…Pulmonary thromboembolism (PTE) is the third leading cause of death related to cardiovascular disease, in which acute right ventricular failure and pulmonary infarction are the main complications (1). Some studies have reported that pulmonary infarction occurs in 29% to 32% of patients with PTE (1)(2)(3).…”

“…Some studies have reported that pulmonary infarction occurs in 29% to 32% of patients with PTE (1)(2)(3).…”

Acute ischaemic lung injury due to pulmonary vascular obstruction

“…Vascular obstruction of the lung classically causes reversible pulmonary haemorrhage or irreversible pulmonary infarction . The incidence of pulmonary infarction was reported recently to be approximately 30% in cases of acute pulmonary embolism and 3–10% in cases of bronchogenic carcinoma …”

“…5,6 Vascular obstruction of the lung classically causes reversible pulmonary haemorrhage or irreversible pulmonary infarction. [1][2][3][4]7 The incidence of pulmonary infarction was reported recently to be approximately 30% in cases of acute pulmonary embolism 8,9 and 3-10% in cases of bronchogenic carcinoma. 5,6,10 We have encountered previously the presence of distinctive lobule-sized myxomatous or fibrous alveolar wall thickening around infarctions, 10 including one case that showed radiologically diffuse pulmonary opacities.…”