ISSN 1004-4140
CN 11-3017/P
ZHANG H P, WU X H, ZHAO T R, et al. CT manifestations of pulmonary infarction secondary to acute pulmonary embolism[J]. CT Theory and Applications, 2022, 31(2): 227-235. DOI: 10.15953/j.ctta.2021.018. (in Chinese).
Citation: ZHANG H P, WU X H, ZHAO T R, et al. CT manifestations of pulmonary infarction secondary to acute pulmonary embolism[J]. CT Theory and Applications, 2022, 31(2): 227-235. DOI: 10.15953/j.ctta.2021.018. (in Chinese).

CT Manifestations of Pulmonary Infarction Secondary to Acute Pulmonary Embolism

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  • Received Date: October 14, 2021
  • Accepted Date: November 19, 2021
  • Available Online: November 25, 2021
  • Published Date: March 31, 2022
  • Objective: To investigate the CT findings of pulmonary infarction (PI) secondary to acute pulmonary embolism (APE). Method: The clinical and CT data of 41 patients with PI secondary to APE were analyzed retrospectively. The number, location, shape, margin of PI, pleural effusion and dynamic changes were summarized. Results: CT features of PI: (1) Number and location: Among the total 79 PI lesions, 18 patients had single lesion and 23 patients had multiple lesions. All lesions were located under the pleura and connected to the pleura with a broad base, 46.8% (37/79) were located in the lower lobe of the right lung, 36.7% (29/79) in the lower lobe of the left lung, 3.8% (3/79) in the upper lobe, 6.3% (5/79) in the middle lobe of the right lung, and 6.3% (5/79) in the lingual segment of the upper lobe of the left lung. (2) Shape: 45.6% (36/79) of the lesions showed Reversed Halo Sign (RHS), 36.7% (29/79) displayed consolidation of oval, wedge or hump, 17.7% (14/79) revealed ground glass opacity. (3) Bronchovascular bundles in PI: Bronchovascular bundles were found in 79.7% (63/79) of PI. In 21.3% (16/79) of the cases, there was no bronchovascular bundle in the lesion because of its small size; (4) After enhancement, there was no enhancement shown in the 79 PI lesions. (5) All 79 lesions changed into patchy or linear during the end of the treatment period. (6) Pleural effusion: 63.4% (26/41) of patients had pleural effusion, among whom 42.3% (11/26) had bilateral pleural effusion, and 57.7% (15/26) had unilateral pleural effusion. Conclusion: The imaging manifeatations of PE secondary to API hole certain characteristics. For single or multiple lesions under the pleura, with RHS, consolidation of wedge or hump, bronchovascular bundles, APE secondary to API should be considered. In addition, pleural effusion is helpful for diagnosis.
  • [1]
    HE H, STEIN M W, ZALTA B, et al. Pulmonary infarction: Spectrum of findings on multidetector helical CT[J]. Journal of Thoracic Imaging, 2006, 21(1): 1−7. DOI: 10.1097/01.rti.0000187433.06762.fb.
    [2]
    STEIN P D, MATTA F, MUSANI M H, et al. Silent pulmonary embolism in patients with deep venous thrombosis: A systematic review[J]. The American Journal of Medicine, 2010, 123(5): 426−431. DOI: 10.1016/j.amjmed.2009.09.037.
    [3]
    ISLAM M, FILOPEI J, FRANK M, et al. Pulmonary infarction secondary to pulmonary embolism: An evolving paradigm[J]. Respirology, 2018, 23(9): 866−872. DOI: 10.1111/resp.13299.
    [4]
    MANÇANANO A D, RODRIGUES R S, BARRETO M M, et al. Incidence and morphological characteristics of the reversed halo sign in patients with acute pulmonary embolism and pulmonary infarction undergoing computed tomography angiography of the pulmonary arteries[J]. Jornal Brasileiro de Pneumologia: Publicacao Oficial da Sociedade Brasileira de Pneumologia Tisilogia, 2019, 45(1): e20170438. DOI: 10.1590/1806-3713/e20170438.
    [5]
    李菲, 唐笑先, 师建强, 等. 不同类型急性肺栓塞临床相关因素分析及胸部继发改变的CT肺动脉成像特征[J]. 中华放射学杂志, 2018,52(1): 9−14. DOI: 10.3760/cma.j.ssn.1005?1201.2018.01.03.

    LI F, TANG X X, SHI J Q, et al. Clinical correlative factors and CT pulmonary angiography characteristics of secondary changes of chest in different types of acute pulmonary embolism[J]. Chinese Journal of Radiology, 2018, 52(1): 9−14. DOI: 10.3760/cma.j.ssn.1005?1201.2018.01.03. (in Chinese).
    [6]
    GOLDHABER S Z, VISANI L, DE ROSA M. Acute pulmonary embolism: Clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER)[J]. Lancet, 1999, 353: 1386−1389. DOI: 10.1016/s0140-6736(98)07534-5.
    [7]
    MINIATI M. Pulmonary infarction: An often unrecognized clinical entity[J]. Seminars in Thrombosis and Hemostasis, 2016, 42(8): 865−869. DOI: 10.1055/s-0036-1592310.
    [8]
    MARCHIORI E, MENNA BARRETO M, PEREIRA FREITAS H M, et al. Morphological characteristics of the reversed halo sign that may strongly suggest pulmonary infarction[J]. Clinical Radiology, 2018, 73: 503.e7−503.e13. DOI: 10.1016/j.crad.2017.11.022.
    [9]
    TORBICKI A, PERRIER A, KONSTANTINIDES S, et a1. Guidelines on the diagnosis and management of acute pulmonary embolism: The task force for the diagnosis and management of acute pulmonary embolism of the european society of cardiology (ESC)[J]. European Heart Journal, 2008, 29(18): 2276−2315. DOI: 10.1093/eurheartj/ehn310.
    [10]
    KAPTEIN F H J, KROFT L J M, HAMMERSCHLAG G, et al. Pulmonary infarction in acute pulmonary embolism[J]. Thrombosis Research, 2021, 202: 162−169. DOI: 10.1016/j.thromres.2021.03.022.
    [11]
    BLOOMER W E, HARRISON W. Respiratory function and blood flow in the bronchial artery after ligation of the pulmonary artery[J]. The American Journal of Physiology, 1949, 157(2): 317−328. DOI: 10.1152/ajplegacy.1949.157.2.317.
    [12]
    WAGENVOORT C A. Pathology of pulmonary thromboembolism[J]. Chest, 1995, 107(Sl): 10S−17S. DOI: 10.1378/chest.107.1_supplement.10s.
    [13]
    VOLOUDAKI A E, BOUROS D E, FROUDARAKIS M E, et al. Crescentic and ring-shaped opacities: CT features in two cases of bronchiolitis obliterans organizing pneumonia (BOOP)[J]. Acta Radiologica, 1996, 37(6): 889−892. DOI: 10.1177/02841851960373P289.
    [14]
    MARCHIORI E, HOCHHEGGER B, ZANETTI G. Importance of the reversed halo sign for diagnosis of mucormycosis[J]. The Lancet. Infectious Diseases, 2020, 20(5): 538. DOI: 10.1016/S1473-3099(20)30266-8.
    [15]
    蒋玮丽, 龙斌, 柏玉涵, 等. 新型冠状病毒肺炎的胸部CT特征[J]. 中国医学影像学杂志, 2020,28(11): 817−819, 824. DOI: 10.3969/j.issn.1005-5185.2020.11.005.

    JIANG W L, LONG B, BAI Y H, et al. Chest CT features of COVID-19[J]. Chinese Journal of Medical Imaging, 2020, 28(11): 817−819, 824. DOI: 10.3969/j.issn.1005-5185.2020.11.005. (in Chinese).
    [16]
    SALES A R, CASAGRANDE E M, HOCHHEGGER B, et al. The reversed halo sign and COVID-19: Possible histopathological mechanisms related to the appearance of this imaging finding[J]. Archivos de Bronconeumologia, 2021, 57: 73−75. DOI: 10.1016/j.arbres.2020.06.029.
    [17]
    张旭辉, 陈晓荣, 陈涛. 以反晕征为主要表现的间质型肺结核一例[J]. 放射学实践, 2020,2: 253−254. doi: 10.13609/j.cnki.1000-0313.2020.02.027
    [18]
    MARCHIORI E, ZANETTI G, IRION KL, et al. Reversed halo sign in active pulmonary tuberculosis: Criteria for differentiation from cryptogenic organizing pneumonia[J]. American Journal of Roentgenology, 2011, 197: 1324−1327. DOI: 10.2214/AJR.11.6543.
    [19]
    童永秀, 张玮, 张惠娟, 等. 以反晕征为主要CT表现的继发性肺结核影像特征分析[J]. 临床放射学杂志, 2020,(1): 69−72. DOI: 10.13437/j.cnki.jcr.2020.01.014.

    TONG Y X, ZHANG W, ZHANG H J, et al. Aanlysis the imaging features of secondary pulmonary tuberculosis with reversed halo sign as the manifestation[J]. Journal of Clinical Radiology, 2020, (1): 69−72. DOI: 10.13437/j.cnki.jcr.2020.01.014. (in Chinese).
    [20]
    车宏伟, 张晓琴, 柴军, 等. 新型冠状病毒肺炎临床表现及CT影像学分析[J]. CT理论与应用研究, 2021,30(4): 525−532. DOI: 10.15953/j.1004-4140.2021.30.04.14.

    CHE H W, ZHANG X Q, CHAI J, et al. Clinical manifestations and CT imaging analysis of corona virus disease 2019[J]. CT Theory and Applications, 2021, 30(4): 525−532. DOI: 10.15953/j.1004-4140.2021.30.04.14. (in Chinese).
    [21]
    NATTUSAMY L, MADAN K, KHILNANI G C, et al. Pulmonary infarction in acute pulmonary embolism: Reversed halo sign[J]. BMJ Case Reports, 2014: bcr2014205181. DOI: 10.1136/bcr-2014-205181.
    [22]
    GOSHIMA H, TOMIOKA H, NISHIO C, et al. Reversed halo sign in pulmonary infarction with tumor emboli: A case report[J]. Respiratory Investigation, 2014, 52(3): 199−202. DOI: 10.1016/j.resinv.2013.08.004.
    [23]
    周旭辉, 李菁, 李子平, 等. 肺动脉栓塞中发生肺梗死的CT表现及相关因素分析[J]. 中华放射学杂志, 2006,40(5): 502−506. DOI: 10.3760/j.issn:1005-1201.2006.05.012.

    ZHOU X H, LI J, LI Z P, et al. Analysis of finding and correlative factors for pulmonary infarction complicated with pulmonary embolism[J]. Chinese Journal of Radiology, 2006, 40(5): 502−506. DOI: 10.3760/j.issn:1005-1201.2006.05.012. (in Chinese).
    [24]
    CHOI S H, CHA S I, SHIN K M, et al. Clinical relevance of pleural effusion in patients with pulmonary embolism[J]. Respiration, 2017, 93(4): 271−278. DOI: 10.1159/000457132.
    [25]
    KOCIJANCIC I, VIDMAR J, KASTELIC M. Dynamics of CT visible pleural effusion in patients with pulmonary infarction[J]. Radiology and Oncology, 2018, 52(3): 245−249. DOI: 10.2478/raon-2018-0033.
    [26]
    王璐, 易坤明, 毛锐利, 等. 大叶性肺炎与肺炎型肺癌患者的CT影像分析[J]. 中华医院感染学杂志, 2018,28(23): 3568−3571. DOI: 10.11816/cn.ni.2018-173844.

    WANG L, YI K M, MAO R L, et al. CT imaging study of patients with lobar pneumonia and pneumonia-type lung cancer[J]. Chinese Journal of Nosocomiology, 2018, 28(23): 3568−3571. DOI: 10.11816/cn.ni.2018-173844. (in Chinese).
    [27]
    王庆宜, 李万湖, 张德贤, 等. 原发性肺浸润型黏液腺癌影像学表现及病理特点[J]. 中华肿瘤防治杂志, 2020,27(8): 647−652, 657. DOI: 10.16073/j.cnki.cjcpt.2020.08.11.

    WANG Q Y, LI W H, ZHANG D X, et al. Imaging findings and pathological features of primary lung invasive mucinous adenocarcinoma[J]. Chinese Journal of Cancer Prevention and Treatment, 2020, 27(8): 647−652, 657. DOI: 10.16073/j.cnki.cjcpt.2020.08.11. (in Chinese).

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