CTICasesExtensive Pulmonary Embolism with Cavitating Infarction
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Imaging findings
CT pulmonary angiography demonstrated a large, extensive filling defect in the right pulmonary artery, extending into the interlobar, lobar, and segmental vessels, causing diminished perfusion of the right lower lobe. Peripheral, ill-defined opacities were consistent with pulmonary hemorrhage or infarction. Subsequent imaging showed the infarct growing and eventually cavitating. Pathologic specimens revealed organizing clot, described as "chronic white clot."
Key takeaways
Large pulmonary emboli, especially if subacute or chronic ("white, tenacious clot"), can be resistant to thrombolysis and may require surgical embolectomy. Such emboli can lead to extensive pulmonary parenchymal infarction, which can progress to cavitation. The heart may tolerate large emboli if they develop over time, allowing for physiological adaptation.
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