Pulmonary cavitation following pulmonary infarction

Area of Science:

• Pulmonary Medicine
• Radiology
• Pathology

Background:

• Cavitary lung disease diagnosis can be challenging.
• Bland pulmonary infarction is rarely considered in the differential diagnosis of cavitary lung disease.

Purpose of the Study:

• To determine the incidence and characteristics of cavitating pulmonary infarction (CPI).
• To evaluate the diagnostic challenges and clinical presentation of CPI.

Main Methods:

• Retrospective review of serial chest radiographs from autopsies with pulmonary infarction.
• Inclusion of cases with positive ventilation-perfusion lung scans.
• Comparison with 31 previously reported cases of CPI.

Main Results:

• Identified 10 new cases of CPI, with 12 radiographic cavities.
• Observed rapid cavitation development (mean 5 days) in nine patients.
• Commonly associated symptoms included fever, purulent sputum, and leukocytosis; bacterial pathogens identified.

Conclusions:

• Cavitating pulmonary infarction occurs with higher frequency than commonly recognized.
• CPI should be considered in the differential diagnosis of patients presenting with cavitary lung lesions.
• Delayed diagnosis, often at autopsy, is a significant issue.