CTICasesPulmonary Embolism with Oval Infarct
Imaging findings
An oncology patient has a new ill-defined pleural-based opacity with adjacent pleural fluid; on the lateral view it is contiguous with the pleural surface and oval rather than wedge-shaped. Over about two weeks, an area initially representing pulmonary hemorrhage from acute pulmonary embolism in the left lower lobe evolved into a discrete area of infarcted lung, with a small pleural effusion.
Key takeaways
A pulmonary infarct from embolism characteristically evolves from an area of hemorrhage to consolidated infarcted lung over one to two weeks and is typically pleural-based and rounded or oval rather than truly wedge-shaped, dispelling the myth that infarcts are wedge-shaped. Recognizing the temporal evolution and morphology allows confident attribution to pulmonary embolism.
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