CTICasesPulmonary Infarct with Pleural Effusion ("Orange Peel" Sign)
▶ Watch on YouTube — age-restricted, cannot embed here
Imaging findings
A chest radiograph shows a right-sided pleural effusion in a patient with heart failure (EF 15-20%) and a defibrillator. CT reveals a lesion in the right lower lobe, characterized by a subtle rim of increased attenuation and the absence of air bronchograms in its center, which has been likened to an 'orange peel' or 'blood orange' appearance. The patient had a known massive thrombus in the left ventricle and a massive pulmonary embolism in the right lower lobe (missed on an outside CT). The pleural effusion was exudative, initially had significant output via pigtail catheter, but cytology and pathology were negative, and it eventually improved.
Key takeaways
Pulmonary infarcts frequently present with peripheral, often wedge-shaped opacities, typically lacking air bronchograms, and may exhibit a 'reverse halo' or 'orange peel' sign with a hemorrhagic rim and central pulp-like area. Pleural effusions are a common accompanying feature of pulmonary infarcts, and can be exudative. Identifying the underlying cause, such as a left ventricular thrombus or pulmonary embolism, is crucial.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Massive GoiterMetabolic
- Macklin Phenomenon (Pneumomediastinum)Trauma
- Familial Pleuroparenchymal FibroelastosisILD
- Paratracheal Hematoma (Post-Aortic Stent Placement)Iatrogenic
- Tracheobronchomalacia (Severe)Congenital
- Pulmonary Arterial Hypertension with Recurrent HemoptysisVascular
- Massive Paraesophageal VaricesVascular
- Ganglioneuroma (Cystic Posterior Mediastinum)Neoplastic
See all cases from May 18, 2016 →