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Published on: August 24, 2019
Clinical characteristics of patients with pulmonary infarction - A retrospective review
Tayoot Chengsupanimit1, Baskaran Sundaram2, Wayne Bond Lau3
1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
Background:
Pulmonary infarction is an infrequent complication of pulmonary embolism. Traditionally, it has been regarded as a sign of worse outcome because ischemia can only occur by the simultaneous failure of all oxygenation sources to the area of infarct, but supporting evidence is limited.
Methods:
We identified 74 cases of pulmonary infarction over 5 years at a single academic center via review of radiographic reports. Contrast-enhanced chest CT scans were examined to confirm evidence of pulmonary infarction, and patient clinical characteristics and imaging results were studied.
Results:
Survival to discharge was high (97%). Patients most commonly presented with dyspnea (69%), chest pain (46%), and swelling or pain in the lower extremities (31%), while underlying risk factors included history of malignancy (41%) and surgery within 30 days (24%). Many patients had concurrent cardiovascular (59%) and pulmonary disease (22%). Infarction disproportionately affected the lower lobes.
Conclusions:
Survival after diagnosis of pulmonary infarction is comparable to uncomplicated pulmonary embolism, suggesting that outcome is not worse. While emboli occurred in multiple lobar sites, pulmonary infarction occurred most commonly in the lower lobes, suggesting unique underlying physiological mechanisms in pulmonary infarction development.
Insights
Pulmonary infarction, a complication of pulmonary embolism, does not worsen patient outcomes. Survival rates are similar to uncomplicated pulmonary embolism, with lower lobes being disproportionately affected.
Area of Science:
- Pulmonary Medicine
- Radiology
- Cardiovascular Medicine
Background:
- Pulmonary infarction is an uncommon complication of pulmonary embolism.
- Traditionally, it has been associated with worse outcomes due to ischemia, but evidence is limited.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of patients with pulmonary infarction.
- To compare the prognosis of pulmonary infarction with uncomplicated pulmonary embolism.
Main Methods:
- Retrospective review of 74 cases of pulmonary infarction over 5 years at an academic center.
- Confirmation of pulmonary infarction using contrast-enhanced chest CT scans.
- Analysis of patient demographics, clinical presentation, risk factors, comorbidities, and imaging findings.
Main Results:
- High survival to discharge rate (97%).
- Common presenting symptoms included dyspnea, chest pain, and lower extremity swelling/pain.
- Frequent risk factors were malignancy and recent surgery; many patients had concurrent cardiovascular and pulmonary diseases.
- Pulmonary infarction predominantly affected the lower lobes.
Conclusions:
- Survival after pulmonary infarction diagnosis is comparable to uncomplicated pulmonary embolism, refuting the notion of a worse prognosis.
- The predilection for lower lobe involvement suggests unique physiological mechanisms in pulmonary infarction development.
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