CTICasesHemorrhagic Pulmonary Infarctions
Imaging findings
Initial contrast-enhanced CT shows severe cardiogenic pulmonary edema characterized by smooth interlobular septal thickening, pleural effusions, peribronchial cuffing, and a dilated left ventricle with apical thrombus. A follow-up non-contrast CT three weeks later shows dense, wedge-shaped consolidations with a peripheral rind of high attenuation and central ground-glass opacities in both lower lobes.
Key takeaways
Severe left ventricular failure (ejection fraction < 20%) can lead to hemorrhagic pulmonary infarctions, which appear as dense, peripheral, wedge-shaped consolidations with a high-attenuation "rind" on non-contrast CT. This appearance can closely mimic angioinvasive fungal infections (like mucormycosis) on imaging, but the clinical context of severe heart failure and lack of immunosuppression helps guide the diagnosis.
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