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A3951 - Clinical Characteristics of Patients with Pulmonary Infarction: A Retrospective Review
Author Block: T. Chengsupanimit1, B. Sundaram2, W. B. Lau3, G. C. Kane4; 1Sidney Kimmel Medical College, Philadelphia, PA, United States, 2Radiology, Thomas Jefferson University, Philadelphia, PA, United States, 3Emergency Medicine, Thomas Jefferson University, Philadelphia, PA, United States, 4Medicine, Thomas Jefferson University, Philadelphia, PA, United States.
RATIONALE
Pulmonary infarction is an uncommon and poorly understood complication of pulmonary embolism (PE). Pulmonary infarction is traditionally thought to be a sign of poor outcome, as failure of all sources of oxygen supply to lung parenchyma at the same time to cause ischemia must suggest a greater extent of pulmonary arterial occlusion or the occurrence of pulmonary embolism in an already compromised patient. Recent reports have caused some to suggest that pulmonary infarction may not correlate with mortality or clinical hemodynamic instability.
METHODS
We performed a retrospective analysis of pulmonary infarction occurring at Thomas Jefferson University Hospital between 2012-2016 to describe the clinical presentation and risk factors and examine the clot burden and location. We hypothesized that patients with pulmonary infarction may not have a worse outcome than patients with pulmonary embolism in general.
RESULTS
Out of 74 patients included in our study, 45% were male and 55% were female. The average age was 55 ± 16 years. Most patients survived to discharge (97%), with a slight reduction in survival rates at 3 months and 6 months (93% and 88%, respectively). Patients most commonly presented with dyspnea (69%), chest pain (46%), and swelling or pain in the lower extremities (31%). At presentation, fever and hemoptysis were less common (11% and 4% respectively).
The most common underlying risk factor in our case series was history of malignancy (41%), followed by surgery within 30 days (24%). Trauma or injury prior to presentation was not a common underlying risk factor for pulmonary embolization (3%). Over half of the patients (59%) had underlying cardiovascular disease, while a minority had concurrent pulmonary disease (22%).
Of interest, while pulmonary emboli were more evenly distributed through all lobes (between 26%-51% of patients with lobe affected), pulmonary infarcts were concentrated in the lower lobes (74% of all infarcts) suggesting unique physiology in these lung zones which may contribute to the development of infarction after PE.
CONCLUSION
We describe the characteristics of a cohort of 74 patients with pulmonary infarction over a 5 year period at our academic medical center in Philadelphia. The survival rates to discharge, at 3 months, and at 6 months were 97%, 92%, and 87% respectively. Chest pain was present in almost half our cases while hemoptysis was rare. The predilection of pulmonary infarction for the lower lobes suggests that there is unique physiology in the lower lung zones as explanation for this phenomenon.