Pulmonary Embolism With Pulmonary Infarction

A 72-year-old woman had complained of shortness of breath for the past week. A CT scan showed a large filling defect in the left main pulmonary artery (Figure A, thin arrows) that extended into both the upper and lower branches. Another filling defect (not shown here) was seen along the posterior wall of the right main pulmonary artery, extending into the lower branch. These defects are compatible with pulmonary emboli.

A large area of alveolar consolidation occupying much of the apicoposterior segment of the left upper lobe (Figure A, arrowheads; and Figure B, arrows) may represent pneumonia, but infarction was considered more likely because of the associated gross pulmonary embolism and the absence of fever and leukocytosis. Small bilateral pleural effusions were also noted (Figure A, thick black arrows). Dr Pramod Kelkar of Chicago treated the patient initially with heparin and later with warfarin. Her shortness of breath resolved, and she was able to go home, where she continued oral anticoagulation therapy.