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Is It Possible to Recognize Pulmonary Infarction on Multisection CT Images?¹

¹ From the Assistance Publique des Hôpitaux de Paris, Paris, France (M.P.R., R.T., G.C., S.C., N.H., A.H., C.D., G.F.); Department of Radiology (M.P.R., R.T., S.C., N.H., A.H., G.F.), Clinical Research Unit (G.C.), and Laboratory of Anatomy and Pathology (C.D.), Hôpital Européen Georges Pompidou, 20 rue Leblanc, F75015 Paris, France; and Université Paris Descartes, Paris, France (M.P.R., R.T., G.C., S.C., N.H., A.H., C.D., G.F.). Received May 16, 2006; revision requested July 12; revision received September 8; accepted October 12; final version accepted March 1, 2007. Address correspondence to M.P.R. (e-mail: marie-pierre.revel{at}egp.aphp.fr).

View larger version (19K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Flow diagrams for the groups (a) with infarct and (b) without infarct. BAC = bronchiolo-alveolar cell carcinoma, COP = cryptogenic organizing pneumonia.

View larger version (20K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Flow diagrams for the groups (a) with infarct and (b) without infarct. BAC = bronchiolo-alveolar cell carcinoma, COP = cryptogenic organizing pneumonia.

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Transverse contrast-enhanced CT scans show pulmonary infarction in lower lobe of left lung in a 37-year-old man. (a) Mediastinal window setting. (b) Lung window setting. Wedge-shaped peripheral consolidation (arrow) shows central foci of hypoattenuation with no linear shape or bifurcation on a. These central lucencies are better seen on a than on b. Air bronchogram is absent. This patient had associated iliac vein thrombosis at CT venography, chest pain, and hemoptysis.

View larger version (189K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Transverse contrast-enhanced CT scans show pulmonary infarction in lower lobe of left lung in a 37-year-old man. (a) Mediastinal window setting. (b) Lung window setting. Wedge-shaped peripheral consolidation (arrow) shows central foci of hypoattenuation with no linear shape or bifurcation on a. These central lucencies are better seen on a than on b. Air bronchogram is absent. This patient had associated iliac vein thrombosis at CT venography, chest pain, and hemoptysis.

View larger version (107K): [in this window] [in a new window] [Download PPT slide]   Figure 3a: Transverse contrast-enhanced CT scans show consolidation with central lucencies in a 68-year-old woman with pulmonary infarction in the upper lobe of the left lung. (a) Mediastinal window setting. (b) Lung window setting. The central portion of hypoattenuation, better seen on a than on b, is surrounded by dense consolidation (arrow), which probably reflects a peripheral inflammatory reaction. Air bronchograms are absent. This patient had PE involving several segmental and subsegmental pulmonary arteries (not shown).

View larger version (161K): [in this window] [in a new window] [Download PPT slide]   Figure 3b: Transverse contrast-enhanced CT scans show consolidation with central lucencies in a 68-year-old woman with pulmonary infarction in the upper lobe of the left lung. (a) Mediastinal window setting. (b) Lung window setting. The central portion of hypoattenuation, better seen on a than on b, is surrounded by dense consolidation (arrow), which probably reflects a peripheral inflammatory reaction. Air bronchograms are absent. This patient had PE involving several segmental and subsegmental pulmonary arteries (not shown).

View larger version (71K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Transverse contrast-enhanced CT scan obtained with mediastinal window setting shows pulmonary infarction in upper lobe of the right lung in a 43-year-old man. Peripheral consolidation (arrowhead) is seen. Central lucencies and enlarged vessel (arrow) leading to the apex of the wedge-shaped consolidation are clearly visible. Air bronchogram is absent. Central embolism was present on adjacent CT sections.

View larger version (119K): [in this window] [in a new window] [Download PPT slide]   Figure 5a: Pathologically proved pulmonary infarction in the lower lobe of the left lung in a 65-year-old man. (a) Transverse unenhanced CT scan obtained with mediastinal window setting shows central lucencies visible within the consolidation (arrow). (b) Photomicrograph of core biopsy material from the infarcted area showed that the central area (bottom of the figure) was necrotic. Only ghosts of alveolar walls can be seen, with acidophilic cells and nuclear loss, and alveolar lumen are empty. Biopsy was performed to find the cause of chronic unexplained consolidation in the lower lobe of the left lung. Malignancies such as pulmonary lymphoma or bronchiolo-alveolar cell carcinoma were suspected. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (69K): [in this window] [in a new window] [Download PPT slide]   Figure 5b: Pathologically proved pulmonary infarction in the lower lobe of the left lung in a 65-year-old man. (a) Transverse unenhanced CT scan obtained with mediastinal window setting shows central lucencies visible within the consolidation (arrow). (b) Photomicrograph of core biopsy material from the infarcted area showed that the central area (bottom of the figure) was necrotic. Only ghosts of alveolar walls can be seen, with acidophilic cells and nuclear loss, and alveolar lumen are empty. Biopsy was performed to find the cause of chronic unexplained consolidation in the lower lobe of the left lung. Malignancies such as pulmonary lymphoma or bronchiolo-alveolar cell carcinoma were suspected. (Hematoxylin-eosin stain; original magnification, x100.)

View larger version (132K): [in this window] [in a new window] [Download PPT slide]   Figure 6a: Transverse unenhanced CT images obtained with (a) mediastinal and (b) lung window settings show consolidation (arrow) in a 77-year-old man with pathologically proved cryptogenic organizing pneumonia. Air bronchograms are visible on both images.

View larger version (163K): [in this window] [in a new window] [Download PPT slide]   Figure 6b: Transverse unenhanced CT images obtained with (a) mediastinal and (b) lung window settings show consolidation (arrow) in a 77-year-old man with pathologically proved cryptogenic organizing pneumonia. Air bronchograms are visible on both images.