Imaging Sciences Interesting Cases
Case 287
Nadia F. Yusaf, MD
Clinical Presentation: A 36-year-old female presented to the Emergency Department with shortness of breath and chest pain.
Imaging Findings: Chest x-ray showed prominence of the right hilum due to pulmonary embolism in the right pulmonary artery- as well as pulmonary infarct involving the right middle lobe. CT scan showed the embolism in the right pulmonary artery with adjacent pulmonary infarct.
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Figure 1: Chest x-ray shows pulmonary infarction involving the right middle lobe and right hilar prominence. |
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| Figure 2: Chest CT with contrast shows pulmonary embolism in the right pulmonary artery. |
Diagnosis: Pulmonary infarction
Discussion: Less than 10% of all pulmonary embolisms (PEs) lead to a pulmonary infarct, due to collateral vessels. Patients with underlying heart disease are more prone to infarction because of limited collateral circulation. Evidence of an infarction includes pleural effusion and wedge shaped opacity (Hampton hump). The Hampton hump is homogenous, located in the costophrenic sulcus and lacks air bronchograms. In embolism with infarction, airspace opacities take longer to resolve (weeks to months versus days in embolism without infarction).
References:
- Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. 3rd Ed., Lippincott, Williams, and Wilkins, 2006.