CTICasesAcute Pulmonary Embolism with Infarct on Non-Contrast CT
Imaging findings
A 70-year-old with rheumatoid-arthritis-associated interstitial lung disease, a few weeks after single-lung transplant, became acutely hypoxemic. A non-contrast CT (obtained to spare the kidneys) shows peripheral segmental mixed ground glass and consolidation at the right lung base and, importantly, high attenuation within both pulmonary arteries. The subsequent PE study confirmed a large saddle embolus with an area of infarct and a pleural effusion. The explant showed a UIP/NSIP overlap with complex cystic spaces.
Key takeaways
Acute pulmonary embolism can sometimes be recognized prospectively on a non-contrast CT by high attenuation within the pulmonary arteries, which is valuable in transplant and other patients in whom contrast is avoided. A pulmonary infarct develops with an accompanying pleural effusion (a usually sterile exudate) in a substantial minority of cases, and reviewing the outside non-contrast study allowed the diagnosis to be made.
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