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PubMed1995

Pulmonary infarction caused by giant-cell arteritis of the pulmonary artery.

A 79-year-old woman presented with a pulmonary infarction concurrent with a relapse of giant-cell arteritis during tapering off of prednisone. As no origin for thromboembolism could be found, it is very probable that the thrombosis of the branch of the pulmonary artery was superimposed on local giant-cell vasculitis. Rapid clinical and laboratory recovery was achieved with anticoagulant therapy and by increasing the prednisone dosage. The literature on this rare manifestation of giant-cell arteritis is reviewed.

Aged↗
PubMed1993

Pulmonary infarction: sonographic appearance with pathologic correlation.

OBJECTIVE: Peripheral pulmonary lesions are detectable by ultrasound, the aim of this study was to compare sonograms of pulmonary infarctions with their pathological reports. SUBJECTIVE: A total of 26 lung infarcts in 15 non-fixed autopsy lungs of patients showing necroscopically pulmonary embolism were examined sonographically in a water-bath no later than 5 h after autopsy with a 5- or 7.5-MHz sector scanner. Five of these patients were suspected of pulmonary embolism and underwent sonographic examinations shortly before their death. RESULTS: Ultrasound showed mainly wedge-shaped (n = 18), hypoechoic areas. Their location, form and size corresponded exactly with pathological findings. Fresh infarcts were homogeneous and more hypoechoic. Older infarcts were well demarcated and showed a hyperechoic reflex in the center corresponding to the bronchiole; this was a sign of segmental involvement. In two cases it was possible to differentiate thromboembolically congested afferent blood vessel directed to the hilus. Ultrasound images from five living patients were similar to the image of the autopsy lung. CONCLUSION: In accordance with clinical studies these observations suggest that transthoracic sonography can be an efficient technique in the detection of pulmonary infarction, as well in an early reperfusionable stage as in distinguished infarct formation.

Humans↗
PubMed1998

[Resection of a pulmonary infarction presenting as a mass shadow on chest X-ray--case report].

Recently the incidence of pulmonary infarction has increased in Japan. The patient was a 67-year-old male who was examined by a local physician for bloody sputum and a cough. A chest X-ray showed a 5-cm mass shadow in the lower left lung area. Bronchofiberscopy and percutaneous needle biopsy were performed, but they did not permit a definite diagnosis, and since the patient had a 13-year history of penile cancer (squamous cell carcinoma), and metastasis or even primary lung cancer could not be completely ruled out, an open chest biopsy was performed. The postoperative histopathological examination allowed a diagnosis of hemorrhagic pulmonary infarction. We report a case of pulmonary infarction resection that was difficult to diagnose preoperatively.

Aged↗
PubMed1992

[Computerized tomography in pulmonary infarction].

We performed a retrospective study of CT findings in 14 patients with 61 lesions of pulmonary infarction diagnosed clinically and radiographically. All cases except one had multiple pleural-based parenchymal lesions, and in five cases the lesions were bilateral. The site of pulmonary infarction was the right lower lobe in 24 lesions, left lower lobe in 19 lesions, right upper lobe and left upper lobe in seven lesions each, and right middle lobe in four lesions. Fifty-nine infarctions (excluding two segmental lesions) were divided into two groups according to the size of the lesions: a group of lesions 2 cm or more in size and a group less than 2 cm. Nineteen lesions in eight patients were in the larger group and 40 lesions in 12 patients in the smaller group. The typical CT findings of larger infarctions were pleural based parenchymal density with truncated apex, centrally directed linear shadow and inside low attenuation area indicating viable lung. Pleural thickening and effusion were frequently seen. No air bronchograms were seen in these subsegmental lesions. Smaller lesions were believed to indicate infarction of a single secondary pulmonary lobule, considering their size and shape. CT scan was able to detect these small lesions (single lobular infarctions) more frequently than chest radiography. One segmental lesion with air bronchogram was thought to represent atelectasis and the other one to represent pulmonary hemorrhage and edema. CT examination is useful for the detection and diagnosis of pulmonary infarction.

Adult↗
PubMed2000

Multiple pulmonary infarctions associated with lung cancer.

We present a case of right lung adenosquamous cell carcinoma that had obstructed the main pulmonary artery and superior pulmonary vein, causing multiple pulmonary infarctions in the right upper and middle lobes. Multiple peripheral pulmonary nodules showed clinical features that are characteristic of pulmonary infarction: rapid appearance and gradual reduction in size, pleural-based parenchymal density with a truncated apex and a round nodular shadow with a blurred margin and a centrally directed linear shadow. The nodules were more intense than the primary tumor in both T1- and T2-weighted magnetic resonance imaging (MRI). We conclude that pulmonary infarction can look like a nodule when lung cancer invades both the pulmonary artery and vein and that such cases can be distinguished from pulmonary metastasis by MRI, computed tomography and a series of radiological examinations.

Aged↗
PubMed1998

[Three cases of right-sided active endocarditis with multiple pulmonary infarction].

We have experienced three patients with right-sided active endocarditis combined with multiple pulmonary infarction. Ventricular septal defect (VSD), aortic regurgitation (AR), tricuspid regurgitation (TR) and congestive heart failure were present in case 1. TR was present in case 2. VSD, TR and patent ductus arteriosus were present in case 3. alpha-Streptococcus caused endocarditis in case 1 and 3; Candida albicans caused endocarditis in case 2. Antibotic therapy had no effect in case 2 and 3. Case 1 and 3 developed pulmonary hemorrhage, which resolved before the operation in case 1, but not in case 3. Our three patients underwent surgery and recovered successfully. They were discharged on the 43th, 58th and 32th postoperative day and are presently free of clinical symptoms. These experiences suggest surgery should be undertaken in the following situations: 1. antibiotic therapy has no effect on the infection, 2. hemodynamics are worsening, and 3, pulmonary infarction and pulmonary hemorrhage occur repeatedly.

Aged↗
PubMed1988

Episodic ectopic ACTH syndrome associated with pulmonary infarctions.

The etiology of the ectopic ACTH syndrome, associated with certain tumors, is unclear. The ectopic ACTH syndrome was diagnosed in our patient by the characteristic clinical and laboratory findings. Shortly after admission, pulmonary infarctions were documented by lung scans and computed tomography. After treatment with anticoagulants, his plasma ACTH level and its suppressibility became normal. There was no evidence of a tumor. The ectopic ACTH syndrome recurred one year later in conjunction with another episode of pulmonary infarctions. During anticoagulant therapy his infarctions cleared and his plasma ACTH level normalized. In the five years since the onset, no tumor has been found, and plasma ACTH level remains normal and suppressible. We propose that our patient's pulmonary infarctions stimulated pulmonary ACTH production, leading to Cushing's syndrome.

ACTH Syndrome, Ectopic↗
PubMed2006

Pulmonary infarction due to vascular stent migration.

The case of a patient who developed pulmonary infarction after a vascular stent migrated to her pulmonary artery is presented. Stent migration is a known complication of vascular stents. The incidence is reported to be as low as 3%. Cases have been reported of successful retrieval of the stents. There are also reports of the stents being left in place without attempts to retrieve them, due to lack of symptoms. In this case, we opted to monitor the patient, despite the presence of pulmonary infarction. She appears to be tolerating the stent without any further complications.

Female↗
PubMed1991

Pulmonary infarction, myocardial infarction, and acute disseminated intravascular coagulation.

Pulmonary and myocardial damage are frequently cited as manifestations of disseminated intravascular coagulation (DIC), but rarely as causes. Three elderly cases of severe DIC due to pulmonary and myocardial infarction are reported. All three patients died. Necropsy showed extensive pulmonary emboli in each case with large pulmonary infarcts in cases 1 and 2 and a ventricular aneurysm containing thrombus in cases 2 and 3. Early diagnosis and treatment of pulmonary embolism requires a high degree of clinical suspicion but may prevent progression to the irreversible stage of severe DIC.

Aged↗
PubMed1995

[Relations between chest CT and pathologic findings in pulmonary infarction associated with lung cancer].

Chest radiographic (mainly CT), and pathological findings in pulmonary infarction associated with lung cancer were studied to obtain information useful for the interpretation of CT findings, and to help determine the cause of infarction. Sixteen cases of lung infarction were chosen from among 518 cases of lung cancer. All patients were operated on between January 1980 and December 1990. Sixteen surgical cases and one autopsy case all with evidence of lung cancer and infarction were chosen. There were 13 men and 4 women with a mean age of 56 years. Adenocarcinoma was found in 8 cases, squamous cell carcinoma in 6, adenosquamous carcinoma in 2, and small cell carcinoma in 1. Chest radiographs and CT revealed infarction shadows in 8 of the 16 cases. Typical CT findings for pulmonary infarction were: shadows located in the same lobe and periphery as the cancer; ill-defined, 10-25 mm nodular shadows; and lesions located both in the subpleural zone and apart from the pleura. Lesion counts in each area were about the same. Observation of one patient for 2 months revealed a decrease in the size of the nodular shadows and clarification of their margins. In most cases, centrally extended cancer resulted in vascular stenosis and infarction.

Adenocarcinoma↗