A 57-year-old man with chronic obstructive pulmonary disease (COPD), obstructive sleep apnea, and a recent pulmonary embolism (PE) on anticoagulation presented with acute pleuritic chest pain and worsening dyspnea. Computed tomographic angiography (CTA) of the chest revealed a small distal segmental PE in the left lower lobe and an adjacent irregular consolidation, raising concern for pulmonary infarction versus pneumonia. The patient was empirically started on antibiotics for possible pneumonia and admitted for anticoagulation and supportive care. He left the hospital against medical advice (AMA) before completing treatment, but returned days later with exacerbated symptoms. This case highlights the diagnostic challenge of differentiating pulmonary infarction from pneumonia in the context of acute PE. The patient’s course underscores the importance of recognizing imaging and laboratory clues suggestive of infarction, ensuring adequate treatment, and the risks associated with premature discontinuation of care. We discuss the pathophysiology of pulmonary infarction, its clinical and radiologic presentation, and discuss recent literature on management strategies. The case emphasizes the need for high clinical suspicion of pulmonary infarction in PE patients who develop pulmonary opacities, as timely diagnosis can direct appropriate therapy and avoid mismanagement.
Marconi et al. (Thu,) studied this question.
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