CTICasesChronic Pulmonary Thromboembolism with Pulmonary Infarction and Cavitation
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Imaging findings
Chest radiography shows a dilated right atrium, a distended azygos vein, and a prominent right apical opacity. Chest CT demonstrates extensive, chronic, occlusive thrombi in the main and lobar branches of the right pulmonary artery, along with bronchial artery hypertrophy and signs of severe right ventricular strain and pulmonary hypertension. A chronic, cavitating, wedge-shaped peripheral opacity is visible in the right upper lobe, directly supplied by a completely occluded arterial branch.
Key takeaways
Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe sequela of pulmonary embolism characterized by chronic vascular obstruction, right ventricular dysfunction, and bronchial collateral hypertrophy. Chronic pulmonary infarction can lead to wedge-shaped consolidation, necrosis, and cavitation that mimics an infectious cavity or abscess. Pulmonary endarterectomy is the definitive treatment but may be complicated or delayed by conditions like heparin-induced thrombocytopenia (HIT).
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