Pulmonary infarction secondary to pulmonary embolism: An evolving paradigm

Islam, Marjan; Filopei, Jason; Frank, Matthew W.; Ramesh, Navitha; Verzosa, Stacey; Ehrlich, Madeline; Bondarsky, Eric; Miller, Albert; Steiger, David

doi:10.1111/resp.13299

Cited by 29 publications

(44 citation statements)

References 30 publications

(47 reference statements)

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“…Central PE may produce typical angina also due to RV ischemia; while pleuritic chest pain can be the consequence of pleural irritation due to pulmonary infarction secondary to small distal pulmonary artery (PA) embolization. 20) 21) 22) Dyspnea has a multi-factorial origin, resulting from bronchospasm or vasospasm, disturbances in pulmonary circulation, immobility or diminished respiratory excursion of the diaphragm, atelectasia and/or pulmonary infarction, anoxia, or impairment of cardiac function. In patients with pre-existing heart failure or pulmonary disease, deteriorating dyspnea may be the only symptom indicative of PE.…”

Section: Symptoms and Signs Of Pementioning

confidence: 99%

Acute Pulmonary Embolism: Focus on the Clinical Picture

Morrone

2018

Korean Circ J

104

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Acute pulmonary embolism (APE) is characterized by numerous clinical manifestations which are the result of a complex interplay between different organs; the symptoms are therefore various and part of a complex clinical picture. For this reason, it may not be easy to make an immediate diagnosis. This is a comprehensive review of the literature on all the various clinical pictures in order to help physicians to promptly recognize this clinical condition, remembering that our leading role as cardiologists depends on and is influenced by our knowledge and working methods.

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Section: Symptoms and Signs Of Pementioning

confidence: 99%

Acute Pulmonary Embolism: Focus on the Clinical Picture

Morrone

2018

Korean Circ J

104

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“…This seems to be complementary to previous studies, which report significantly lower prevalence of pulmonary infarction in the elderly. 8 , 11 , 12 One of the probable mechanisms for this could be that in elderly patients with chronic cardiopulmonary disease regional hypoxia promotes collateral pulmonary angiogenesis, thus protecting the pulmonary parenchyma from infarction. 11 Another possible mechanism, which could also interfere, is that the dilatation and extension of the bronchial circulation in patients with chronic lung diseases decreases flow dynamics through the established pulmonary circulation.…”

Section: Discussionmentioning

confidence: 99%

Dynamics of CT visible pleural effusion in patients with pulmonary infarction

Kocijančič

Vidmar

Kastelic

2018

Radiology and Oncology

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BackgroundPleural effusion remains largely unexplored in patients with pulmonary embolism and concurrent pulmonary infarction. The aim of the study was to investigate the relationship between the size of pulmonary infarction and pleural effusion as well as the time course of pleural effusion in patients with pulmonary infarction.Patients and methodsData from 103 patients with pulmonary infarction was retrospectively analysed along with patient comorbidities, size of pulmonary infarction, presence and size of pleural effusion with the time between the onset of clinical symptoms of pulmonary infarction and CT study.ResultsAssessment of possible correlations between the size of pulmonary infarction and age revealed a significant negative correlation. There was a highly significant difference (p = 0.005) in the mean size of pulmonary infarction in patients with effusion (34.5 cm3) compared to those without it (14.3 cm3), but the size of the effusion had no correlation with the size of pulmonary infarction. The size of the effusion peaked between 4th–5th day after the onset of clinical symptoms of pulmonary infarction. In the first 5 days after the onset of clinical symptoms of pulmonary infarction a significant correlation was found between the size of the effusion and time with approximation of 1.3 mm/12 h.ConclusionsThe data shows that patients with a pleural effusion are more likely to have a larger pulmonary infarction than those without it. If present, the effusion can be expected to increase in a relatively slow linear fashion in the first 5 days after the onset of clinical symptoms of pulmonary infarction.

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“…The same nonspecific symptoms that are found in PE without infarction may be found when PI is present. PI adds the potential for pleuritic chest pain, haemoptysis, chest wall tenderness and the imaging findings including pulmonary infiltrates and pleural effusion described by Islam et al . While none of these findings are specific for PE with PI, they should always raise suspicion.…”

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confidence: 95%

“…In a recent publication in Respirology , Islam et al . report their single‐centre retrospective review of 367 consecutive patients with acute pulmonary embolism (PE) with a specific focus on the 62 patients with pulmonary infarction (PI) and how they differ from those without PI . Clinical and radiographical data were compared and risk factors for PI were determined.…”

mentioning

confidence: 99%

“…Very commonly, patients with PI have more amorphous appearing pleural‐based infiltrates and these are commonly diagnosed as pneumonia. PI should be considered in the setting of pleural‐based, particularly lower lobe infiltrates and particularly when no fever, chills, sweats or productive cough are present, and in the absence of leucocytosis. While cough may be present in PI, the absence of cough should render the diagnosis of pneumonia far less likely, particularly in young patients, although in elderly, sedated or otherwise obtunded patients, cough may be absent when pneumonia is present.…”

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confidence: 99%

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