CTICasesPulmonary Venous Infarction
Imaging findings
Post-operative, non-contrast and contrast-enhanced chest CT scan obtained three days following a left lower lobe wedge resection reveals a loculated pleural effusion, dense, expanding ground-glass and consolidative opacities in the remaining left lower lobe, and surgical staples. There is a classic 'bird's nest' appearance characterized by central lucencies within the consolidative process, along with complete occlusion and absence of the left inferior pulmonary vein. Gross pathological examination of the resected lobe confirms a severely congested, dark blue-purple, blood-engorged parenchymal infarction.
Key takeaways
Pulmonary venous infarction is a rare but catastrophic post-operative complication of thoracic surgery, typically resulting from the accidental stapling, ligation, or torsion of a pulmonary vein during lobectomy or segmentectomy. Radiographically, the infarcted lung segment appears increasingly dense and edematous, occasionally exhibiting the 'bird's nest' sign, which can easily be misidentified on non-contrast scans as simple postoperative atelectasis, pneumonia, or empyema. Early recognition on contrast-enhanced CT is crucial, as venous infarction causes severe venous congestion, parenchymal necrosis, and systemic sepsis, necessitating urgent surgical re-exploration and completion lobectomy.
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