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PubMed2000

Pulmonary infarction after liver transplant and previous hepatopulmonary syndrome.

We describe the case of a 36-year-old woman with previous hepatopulmonary syndrome in which a focal pulmonary lesion developed after liver transplantation. Thoracoscopic resection showed a pulmonary infarction of the superior segment of the right lower lobe. The patient recovered and had no further thrombotic events after 2 years of follow-up. The pulmonary vascular changes observed during hepatopulmonary syndrome may predispose patients to the development of pulmonary infarction.

Adult↗
PubMed1986

Verminous vasculitis, pneumonia and pulmonary infarction in a cynomolgus monkey after treatment with ivermectin.

An apparently healthy cynomolgus monkey (Macaca fascicularis) died 2 hours after routine inhalation anesthesia and implantation of a femoral catheter. Gross necropsy findings included patchy raised areas of severe pulmonary hemorrhage and consolidation. Filarioid nematodes (Edesonfilaria malayensis) were located in pulmonary blood vessels and in numerous 0.1-2 cm fibrous cysts on the pleural surfaces of the lungs, pericardium, diaphragm, retroperitoneum, and in the urinary bladder wall. Microscopic lesions included verminous vasculitis, pulmonary infarcts and pneumonia. Many of the nematodes were more necrotic than the surrounding host tissue. During quarantine, 17 days before surgery, the monkey had been given a single dose of ivermectin (200 micrograms/Kg, intramuscular) as an anthelminthic for gastrointestinal nematodes. It is postulated that many of the filarioid nematodes were killed by this treatment. These parasitic emboli caused pulmonary infarction and the severe inflammatory reaction. The resulting pulmonary disease compromised pulmonary function and contributed to death after anesthesia. This complication should be considered if monkeys possibly harboring filarioid nematodes are treated with ivermectin.

Animals↗
PubMed1996

[A case of bronchogenic carcinoma associated with pulmonary infarction which showed a tumorous shadow].

The patient was 69-year-old male with bronchogenic carcinoma associated with another abnormal shadow in the same left lower lobe. Its shadow was considered whether obstructive pneumonia or intrapulmonary metastasis before thoracotomy. Pathological examination revealed that this lesion was pulmonary infarction. It may be rare that bronchogenic carcinoma is associated with pulmonary infarction showing tumorous shadow. The staging and operative indication of lung cancer should be carefully determined which associate with abnormal shadow on the same lung field.

Aged↗
PubMed1983

Neonatal pulmonary infarction. A cause of 'cystlike' lucencies on the chest roentgenogram.

Perinatal pulmonary infarction is a difficult and infrequently made diagnosis. A male newborn had infarction of most of the right lung secondary to perinatal pulmonary thromboembolism (PTE). Serial chest roentgenograms initially showed opacity of most of the right lung, followed by the appearance of well-defined radiolucencies resembling pneumatoceles associated with mass effect. By the 25th day of life the localized "cystlike" lucencies were no longer evident and the right lung appeared predominantly hyperlucent. Although the presence of underlying disease makes the diagnosis of PTE in the infant and young child difficult, the clinical features and methods of diagnosis of PTE in this age group are similar to those for the adult. The diagnosis of PTE should be considered in the infant with respiratory distress and unusual findings on chest roentgenography.

Cysts↗
PubMed1989

[A case of pulmonary infarction secondary to subacute bacterial endocarditis with subpulmonary VSD].

A case of pulmonary infarction secondary to subacute bacterial endocarditis of pulmonary valve which is associated with subpulmonary VSD is presented. The jet stream of blood through the subpulmonary VSD made damage to the pulmonary valve, which may be one of the reasons why subacute bacterial endocarditis was associated with the subpulmonary VSD. Echocardiography of the right-sided valves will be very useful in order to detect the pulmonary valve endocarditis in congenital heart disease presenting with fever.

Adult↗
PubMed2001

[Aortitis syndrome associated with ulcerative colitis, preceded by pulmonary infarction involvement].

A 21-year-old woman with a 6-year history of ulcerative colitis admitted to our hospital with chest pain, cough and fever of unknown origin in August 1998. On admission, laboratory data showed positive inflammatory signs. A chest radiograph and chest computed tomogram (CT) revealed nodular shadows in the right upper lung field. Fifty days after admission, hypertension developed and a bruit was audible in the neck and the upper abdomen. Digital subtraction angiography showed stenosis in carotid, renal and right upper pulmonary arteries. On the basis of these results, a diagnosis of aortitis syndrome was made. Moreover, these findings indicated pulmonary infarction in the right upper lobe due to aortitis syndrome. Aortitis syndrome preceded by pulmonary infarction involvement is very rare. Autoimmune disorders may have been involved in this case because of the association with ulcerative colitis.

Adult↗
PubMed1995

[Pulmonary infarct hardly differentiated from lung cancer--a case report].

A 64-year-old woman experienced high grade fever, chest pain, and hemosputum. She was admitted to a hospital for evaluation of the infiltrate on an chest X-ray. She was diagnosed as having lung cancer by sputum cytology and transferred to our hospital for operation. The tumor was obscure on palpation during thoractomy, but malignancy could not be ruled out based on analysis of frozen sections. Therefore, a right lower lobectomy and mediastinal lymph node dissection were performed. Pulmonary infarct was not suspected until thrombi were observed in the dissected pulmonary artery. Urokinase and heparin were intravenously administered soon after the operation, but the patient died of pulmonary thromboembolism of the sixth postoperative day. Examination of the operative specimen revealed pulmonary thromboembolism with infarction and no evidence of malignancy. Atypical cells observed in sputum cytology seemed to be derived from basal cell hyperplasia in the area of infarction. Type II alveolar epithelial cell hyperplasia was observed in the periphery of the infarction. These findings seemed to make accurate analysis of frozen sections difficult. An increasing number of cases of pulmonary thromboembolism is being reported in Japan. Therefore, pulmonary infarct with false positive cytology may be encountered more frequently in the future.

Diagnosis, Differential↗
PubMed1999

[Pulmonary infarction diagnosed by transbronchial lung biopsy].

A 43-year-old man complained of chest pain, fever, and hemosputum in February 1997. Chest X-ray films revealed small opacity in the right lower lung field. The patient received therapy for pneumonia and his condition gradually improved. However, on March 21 he was admitted to our hospital with worsened chest pain and radiographic findings. A transbronchial lung biopsy revealed thrombus and necrosis, thus yielding a diagnosis of pulmonary infarction. The patient did not exhibit any underlying disease or coagulation abnormalities. Treatment with ticlopidine resulted in a favorable course. This was a rare case of pulmonary infarction in which TBLB findings led to the diagnosis.

Adult↗
PubMed2006

Pulmonary infarction: spectrum of findings on multidetector helical CT.

OBJECTIVE: Despite the dual blood supply to the lung, acute pulmonary embolism (PE) can lead to a spectrum of ischemic injury to the lung resulting in infarction and hemorrhage. In this series we systematically describe the spectrum of CT findings and clinical correlates of pulmonary infarction in patients with PE. METHODS: We retrospectively identified 24 consecutive adults with pulmonary infarction on multidetector CT between July 2002 and March 2004. There were 13 women and 11 men, with a mean age of 59 years. The cases were identified by review of 74 consecutive CTs demonstrating PE. Each CT was evaluated by 2 of 3 reviewers in consensus for presence and characteristics of peripheral parenchymal opacities and extent of PE. Peripheral opacities were evaluated for degree of enhancement, internal air lucencies, and contour. The presence of adjacent vessels and linear strands were noted. At the end of interpreting each case, the reviewers determined whether or not an infarct was present based on the constellation of previously described imaging features. The extent of pulmonary vascular obstruction was graded using the CT clot burden scoring system. Each chart was reviewed for predisposing factors for PE and infarction, presenting clinical symptoms/signs, and co-existing pulmonary or cardiac conditions. RESULTS: Thirty-two percent (24/74) of patients with PE had pulmonary infarction. Thirty-three percent (8/24) of patients had more than 1 infarct. Seventy-three percent (27/37) of infarcts were in the lower lobes. The CT findings of pulmonary infarction included: focal decrease in parenchymal enhancement in 95% (35/37), broad pleural base in 65% (24/37), truncated apex in 57% (21/37), convex border in 46% (17/37), internal air lucencies in 32% (12/37), linear stranding from the apex toward the hilum in 24% (9/37), and a thickened vessel leading to the apex of the infarct in 14% (5/37). There was a trend toward a higher mean clot burden (12.3 vs. 10.5) between the patients with PE with and without infarction. Ninety-six percent (23/24) of patients with pulmonary infarction had predisposing factors for infarction, including PE involving more than 1 lobe (n = 21), malignancy (n = 5), and heart failure (n = 3). Pleuritic chest pain was significantly more frequent in patients with infarction (P = 0.0064). CONCLUSION: Pulmonary infarction occurred in nearly 1/3 of patients with PE in this series. The infarcts were peripheral parenchymal opacities characterized by a distinctive complex of findings on CT reflecting ischemic injury in the setting of a dual blood supply to the lung. Pleuritic chest pain was significantly associated with infarction.

Adult↗
PubMed1991

[A case of hypereosinophilic syndrome associated with pulmonary infarction and hepatic vein obstruction (Budd-Chiari syndrome)].

A 21-year-old man was admitted in March 1987 with low grade fever and chest pain. Eosinophilia had been pointed out and PIE syndrome was diagnosed in another hospital a month before admission. Steroid therapy had been started. On the first admission, the chest roentgenogram showed bilateral pleural effusion and a nodular shadow in the left lower lung field. Open lung biopsy was performed and a diagnosis of pulmonary infarction was made. Eosinophilia, low grade fever and chest pain were improved by steroid therapy. He was discharged in April 1987. He was readmitted in September 1987 because of fever, back pain and abdominal distension. On the second admission, eosinophilia (4,510/mm3) was pointed out. The case was diagnosed as hepatic vein obstruction by hepatic vein angiography, liver biopsy and ultrasonic examination. He had transient remission on corticosteroid and anti-coagulant therapy. This case was considered as a rare case of hypereosinophilic syndrome associated with pulmonary infarction and Budd-Chiari syndrome.

Adult↗