PDF herunterladen
Semin Thromb Hemost 2016; 42(08): 865-869
DOI: 10.1055/s-0036-1592310
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Pulmonary Infarction: An Often Unrecognized Clinical Entity

Massimo Miniati
1   Department of Expermental and Clinical Medicine, University of Florence, Florence, Italy
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
15. Oktober 2016 (online)

    Lizenzen und Reprints

Abstract

Pulmonary infarction occurs in nearly one-third of the patients with acute pulmonary embolism. Infarcts are still often mistaken for pneumonia or lung cancer because of the deeply rooted belief that they ought to be triangular in shape. In reality, the apical portion of an embolized region is spared from infarction thanks to sufficient collateral blood flow. Infarcts are always arranged peripherally along the surface of the visceral pleura (costal, diaphragmatic, mediastinal, or interlobar). Their free margin is sharp and convex toward the hilum, casting a semicircular or cushion-like density on chest radiography or computed tomography (CT). Focal areas of hyperlucency within the infarction are often seen on CT. Clinical presentation is nonspecific. Pleuritic chest pain, either isolated or in combination with abrupt dyspnea, is the most frequent presenting symptom, whereas hemoptysis is much rarer. Recent data indicate that younger age, increasing body height, and active cigarette smoking are independent predictors of infarction in the setting of acute pulmonary embolism. Correct recognition of pulmonary infarction is fundamental because pleural-based consolidations suggestive of infarction may be the first manifestation of pulmonary embolism.

Keywords

pulmonary infarction - morphology - risk factors - diagnosis

Funding

None.


 

  • References

  • 1 Virchow R. Weitere Untersuchlungen über die Verstopfung der Lungenarterie und ihre Folgen. Gesammelte Abhandlungen Wissenshaftlichen Medizin; Frankfurt: 1856: 285
    Google Scholar
  • 2 Bloomer WE, Harrison W, Lindskog GE, Liebow AA. Respiratory function and blood flow in the bronchial artery after ligation of the pulmonary artery. Am J Physiol 1949; 157 (2) 317-328
    PubMedGoogle Scholar
  • 3 Liebow AA, Hales MR, Bloomer WE, Harrison W, Lindskog GE. Studies on the lung after ligation of the pulmonary artery; anatomical changes. Am J Pathol 1950; 26 (2) 177-195
    PubMedGoogle Scholar
  • 4 Liebow AA, Hales MR, Harrison W, Bloomer W, Lindskog GE. The genesis and functional implications of collateral circulation of the lungs. Yale J Biol Med 1950; 22 (6) 637-650
    PubMedGoogle Scholar
  • 5 Gurewich V, Thomas D, Stein M, Wessler S. Bronchoconstriction in the presence of pulmonary embolism. Circulation 1963; 27: 339-345
    CrossrefPubMedGoogle Scholar
  • 6 McGoon MD, Vanhoutte PM. Aggregating platelets contract isolated canine pulmonary arteries by releasing 5-hydroxytryptamine. J Clin Invest 1984; 74 (3) 828-833
    CrossrefPubMedGoogle Scholar
  • 7 Hampton AO, Castleman B. Correlation of postmortem chest teleroentgenograms with autopsy findings with special reference to pulmonary embolism and infarction. Am J Roentgenol Radium Ther 1940; 43: 305-326
    PubMedGoogle Scholar
  • 8 Parker BM, Smith JR. Pulmonary embolism and infarction; a review of the physiologic consequences of pulmonary arterial obstruction. Am J Med 1958; 24 (3) 402-427
    CrossrefPubMedGoogle Scholar
  • 9 Dalen JE, Haffajee CI, Alpert III JS, Howe III JP, Ockene IS, Paraskos JA. Pulmonary embolism, pulmonary hemorrhage and pulmonary infarction. N Engl J Med 1977; 296 (25) 1431-1435
    CrossrefPubMedGoogle Scholar
  • 10 Schraufnagel DE, Tsao MS, Yao YT, Wang NS. Factors associated with pulmonary infarction. A discriminant analysis study. Am J Clin Pathol 1985; 84 (1) 15-18
    CrossrefPubMedGoogle Scholar
  • 11 Kent DC, Reid D. Pulmonary embolism in active duty servicemen. Arch Environ Health 1966; 12 (4) 509-517
    CrossrefPubMedGoogle Scholar
  • 12 Gilday DL, James Jr AE. Lung scan patterns in pulmonary embolism versus those in congestive heart failure and emphysema. Am J Roentgenol Radium Ther Nucl Med 1972; 115 (4) 739-750
    CrossrefPubMedGoogle Scholar
  • 13 Miniati M, Pistolesi M, Marini C , et al. Value of perfusion lung scan in the diagnosis of pulmonary embolism: results of the Prospective Investigative Study of Acute Pulmonary Embolism Diagnosis (PISA-PED). Am J Respir Crit Care Med 1996; 154 (5) 1387-1393
    CrossrefPubMedGoogle Scholar
  • 14 Short DS. A radiological study of pulmonary infarction. Q J Med 1951; 20 (79) 233-245
    PubMedGoogle Scholar
  • 15 Fleischner FG. Pulmonary embolism. Can Med Assoc J 1958; 78 (9) 653-660
    PubMedGoogle Scholar
  • 16 Fleischner FG. Pulmonary embolism. Clin Radiol 1962; 13: 169-182
    CrossrefPubMedGoogle Scholar
  • 17 Fleischner FG. Roentgenology of the pulmonary infarct. Semin Roentgenol 1967; 2: 61-76
    CrossrefPubMedGoogle Scholar
  • 18 Larson DB, Johnson LW, Schnell BM, Salisbury SR, Forman HP. National trends in CT use in the emergency department: 1995-2007. Radiology 2011; 258 (1) 164-173
    CrossrefPubMedGoogle Scholar
  • 19 Feng LB, Pines JM, Yusuf HR, Grosse SDUS. U.S. trends in computed tomography use and diagnoses in emergency department visits by patients with symptoms suggestive of pulmonary embolism, 2001-2009. Acad Emerg Med 2013; 20 (10) 1033-1040
    CrossrefPubMedGoogle Scholar
  • 20 Balakrishnan J, Meziane MA, Siegelman SS, Fishman EK. Pulmonary infarction: CT appearance with pathologic correlation. J Comput Assist Tomogr 1989; 13 (6) 941-945
    CrossrefPubMedGoogle Scholar
  • 21 He H, Stein MW, Zalta B, Haramati LB. Pulmonary infarction: spectrum of findings on multidetector helical CT. J Thorac Imaging 2006; 21 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 22 Revel MP, Triki R, Chatellier G , et al. Is It possible to recognize pulmonary infarction on multisection CT images?. Radiology 2007; 244 (3) 875-882
    CrossrefPubMedGoogle Scholar
  • 23 Bell WR, Simon TL, DeMets DL. The clinical features of submassive and massive pulmonary emboli. Am J Med 1977; 62 (3) 355-360
    CrossrefPubMedGoogle Scholar
  • 24 Stein PD, Henry JW. Clinical characteristics of patients with acute pulmonary embolism stratified according to their presenting syndromes. Chest 1997; 112 (4) 974-979
    CrossrefPubMedGoogle Scholar
  • 25 Miniati M, Bottai M, Ciccotosto C, Roberto L, Monti S. Predictors of pulmonary infarction. Medicine (Baltimore) 2015; 94 (41) e1488
    CrossrefPubMedGoogle Scholar
  • 26 Woesner ME, Sanders I, White GW. The melting sign in resolving transient pulmonary infarction. Am J Roentgenol Radium Ther Nucl Med 1971; 111 (4) 782-790
    CrossrefPubMedGoogle Scholar
  • 27 McGoldrick PJ, Rudd TG, Figley MM, Wilhelm JP. What becomes of pulmonary infarcts?. AJR Am J Roentgenol 1979; 133 (6) 1039-1045
    CrossrefPubMedGoogle Scholar
  • 28 Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol 2015; 12 (8) 464-474
    CrossrefPubMedGoogle Scholar
  • 29 Angus GE, Thurlbeck WM. Number of alveoli in the human lung. J Appl Physiol 1972; 32 (4) 483-485
    PubMedGoogle Scholar
  • 30 Knudson RJ, Clark DF, Kennedy TC, Knudson DE. Effect of aging alone on mechanical properties of the normal adult human lung. J Appl Physiol 1977; 43 (6) 1054-1062
    PubMedGoogle Scholar
  • 31 Wood AR, Esko T, Yang J , et al; Electronic Medical Records and Genomics (eMEMERGEGE) Consortium; MIGen Consortium; PAGEGE Consortium; LifeLines Cohort Study. Defining the role of common variation in the genomic and biological architecture of adult human height. Nat Genet 2014; 46 (11) 1173-1186
    CrossrefPubMedGoogle Scholar
  • 32 Mason GR, Uszler JM, Effros RM, Reid E. Rapidly reversible alterations of pulmonary epithelial permeability induced by smoking. Chest 1983; 83 (1) 6-11
    CrossrefPubMedGoogle Scholar
  • 33 Perkins RB, Bradshaw HH. Pulmonary infarction mistaken for bronchogenic carcinoma. J Am Med Assoc 1953; 151 (7) 545-548
    PubMedGoogle Scholar
  • 34 Starzl TE, Brittain RS, Hermann G, Marchioro TL, Waddell WR. Pseudotumors due to pulmonary infarction. Am J Surg 1963; 106: 619-627
    CrossrefPubMedGoogle Scholar
  • 35 George CJ, Tazelaar HD, Swensen SJ, Ryu JH. Clinicoradiological features of pulmonary infarctions mimicking lung cancer. Mayo Clin Proc 2004; 79 (7) 895-898
    CrossrefPubMedGoogle Scholar
  • 36 Yousem SA. The surgical pathology of pulmonary infarcts: diagnostic confusion with granulomatous disease, vasculitis, and neoplasia. Mod Pathol 2009; 22 (5) 679-685
    CrossrefPubMedGoogle Scholar
  • 37 Miniati M. A 48-year-old man with a pleural-based consolidation. CMAJ 2013; 185 (12) 1059-1062
    CrossrefPubMedGoogle Scholar
  • 38 Soussan M, Rust E, Pop G, Morère JF, Brillet PY, Eder V. The rim sign: FDG-PET/CT pattern of pulmonary infarction. Insights Imaging 2012; 3 (6) 629-633
    CrossrefPubMedGoogle Scholar