CTICasesPulmonary Embolism with Pulmonary Hemorrhage
Imaging findings
Chest radiograph performed for shortness of breath shows subtle ill-defined opacities in the right middle lobe. CT pulmonary angiography confirms an acute pulmonary embolism with a filling defect in the right middle lobe pulmonary artery, visible as a grey sausage rather than a white-enhancing vessel on MIP images. There is a corresponding area of non-enhancing opacity in the right middle lobe representing focal pulmonary hemorrhage at the site of embolic occlusion. The non-opacified vessel can be traced directly into the area of hemorrhage.
Key takeaways
Pulmonary embolism can cause focal pulmonary hemorrhage when the embolus occludes a pulmonary artery and the distal lung parenchyma undergoes hemorrhage without full infarction. On CT, MIP images nicely demonstrate the absent enhancement of the occluded vessel with direct continuity into the area of hemorrhage, confirming the vascular etiology. This focal opacity may be mistaken for pneumonia on chest radiograph. The term Hampton's hump describes the classic wedge-shaped peripheral opacity of pulmonary infarction, though the lesion may resolve without true infarction.
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