CTICasesChronic Non-Recanalized Pulmonary Embolism with Hemorrhagic Infarction
Imaging findings
An oncology patient with a central venous catheter developed extensive left pulmonary artery embolism with near-complete filling defect and extensive peripheral non-enhancing opacities showing internal aeration, consistent with pulmonary hemorrhage/hemorrhagic infarction. On follow-up imaging months later the opacities had regressed to small, irregular flat pleural-based scars, and the previously occluded pulmonary artery segment remained obliterated by an organizing fibrotic process that never recanalized, with a coral-reef-like thickened appearance.
Key takeaways
Extensive pulmonary embolism with hemorrhagic infarction can evolve into small residual pleural-based scars, while the causative thrombus itself may never recanalize and instead organizes into chronic fibrotic vascular thickening resembling a coral reef; this demonstrates the variable long-term vascular remodeling that can follow acute PE.
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