Massive pulmonary embolism complicated by pulmonary infarction, haemoptysis and hemothorax

Pulmonary infarction is an uncommon but clinically significant complication of acute pulmonary embolism (PE), resulting from obstruction of distal pulmonary arteries leading to ischaemia, haemorrhage and necrosis of lung parenchyma. We report a case of a man in his 60s who presented with cardiac arrest secondary to massive PE and was treated with systemic thrombolysis. His course was complicated by pulmonary infarction with massive haemoptysis and haemothorax. Due to life-threatening bleeding, anticoagulation was temporarily withheld and an inferior vena cava filter was placed. The patient was managed conservatively with supportive care and antibiotics with gradual clinical and radiological improvement. Anticoagulation was successfully restarted later during hospitalisation, and follow-up imaging demonstrated progressive resolution of the infarction. This case highlights the diagnostic and therapeutic challenges of pulmonary infarction following massive PE and illustrates that even large infarcts can resolve with careful conservative management.