CTICasesHyperacute Pulmonary Infarction progressing to Acute PE with Pleural Effusion
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Imaging findings
Initial non-contrast CT showed dilated pulmonary vessels and a wedge-shaped, heterogeneous consolidation with less dense internal components and a broad pleural base, but no pleural effusion. Follow-up CT with contrast two days later revealed a partially occlusive thromboembolism in the descending pulmonary artery branch, extending into segmental and subsegmental branches, with distension of corresponding vessels. Reactive pleural effusion was present, and the consolidation showed a slightly increased rim of denser tissue around a partially cleared internal component, consistent with pulmonary infarction.
Key takeaways
This case demonstrates the progression of hyperacute pulmonary infarction to acute pulmonary infarction. In the hyperacute phase, there may not be enough time for reactive pleural effusion to develop, despite the presence of pulmonary infarct. The characteristic wedge-shaped consolidation evolves over time.
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