Lung Infarction Following Pulmonary Embolism: A Comparative Study on Clinical Conditions and CT Findings to Identify Predisposing Factors

 

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Abstract

Purpose: The aim of this study was to identify factors predisposing to lung infarction in patients with pulmonary embolism (PE).

Materials and Methods: We performed a retrospective analysis on 154 patients with the final diagnosis of PE being examined between January 2009 and December 2012 by means of a Toshiba Aquilion 64 CT scanner. The severity of clinical symptoms was defined by means of a clinical index with 4 classes. The pulmonary clot load was quantified using a modified severity index of PE as proposed by Miller. We correlated several potential predictors of pulmonary infarction such as demographic data, pulmonary clot burden, distance of total vascular obstruction and pleura, the presence of cardiac congestion, signs of chronic bronchitis or emphysema with the occurrence of pulmonary infarction.

Results: Computed tomography revealed 78 areas of pulmonary infarction in 45/154 (29.2 %) patients. The presence of infarction was significantly higher in the right lung than in the left lung (p < 0.001). We found no correlation between pulmonary infarction and the presence of accompanying malignant diseases (r = –0.069), signs of chronic bronchitis (r = –0.109), cardiac congestion (r = –0.076), the quantified clot burden score (r = 0.176), and the severity of symptoms (r = –0.024). Only a very weak negative correlation between the presence of infarction and age (r = –0.199) was seen. However, we could demonstrate a moderate negative correlation between the distance of total vascular occlusion and the occurrence of infarction (r = –0.504).

Conclusion: Neither cardiac congestion nor the degree of pulmonary vascular obstruction are main factors predisposing to pulmonary infarction in patients with PE. It seems that a peripheral total vascular obstruction more often results in infarction than even massive central clot burden.

Key points:

• A peripheral location of vascular occlusion is the main factor predisposing to pulmonary infarction.

Citation Format:

• Kirchner J, Obermann A, Stückradt S et al. Lung Infarction Following Pulmonary Embolism: A Comparative Study on Clinical Conditions and CT Findings to Identify Predisposing Factors. Fortschr Röntgenstr 2015; 187: 440 – 444

Zusammenfassung

Zielsetzung: Ziel der vorgelegten Arbeit war es, begünstigende Faktoren für das Auftreten eines Infarktes zu finden.

Material und Methoden: Hierzu erfolgte eine retrospektive Analyse von 154 Patienten, bei denen zwischen Januar 2009 und Dezember 2012 anhand einer computertomografischen Untersuchung (Toshiba Aquilion 64) eine Lungenembolie diagnostiziert worden war. Die Schwere der klinischen Symptomatik wurde in 4 Gruppen unterteilt, die embolische Thrombuslast mittels eines modifizierten Miller-Scores quantifiziert. Wir korrelierten das Infarktauftreten mit verschiedenen möglichen prädisponierenden Faktoren wie demografischen Daten, Thrombuslast, dem Abstand zwischen kompletter Gefäßverlegung und der Pleura und computertomografischen Zeichen von kardialer Stauung, chronischer Bronchitis oder Emphysem.

Ergebnisse: Die computertomografische Untersuchung zeigte 78 Infarktzonen bei 45/154 (29,2 %) Patienten, wobei diese signifikant häufiger die rechte Lunge betrafen (p < 0,001). Es zeigten sich weder Korrelationen zwischen einer Infarktbildung und dem Vorliegen einer malignen Begleitdiagnose (r = –0,069), computertomografischen Zeichen der chronischen Bronchitis (r = –0,109) oder Linksherzinsuffizienz (r = –0,076), der Thrombuslast (r = 0,176) noch der Schwere der klinischen Symptomatik (r = –0,024). Eine allenfalls ganz schwache Korrelation zeigte sich zwischen Infarktauftreten und dem Lebensalter (r = –0,199). Unsere Ergebnisse belegten andererseits eine moderate negative Korrelation zwischen der Distanz von kompletter Gefäßverlegung und der abhängigen Pleura (r = –0,504).

Schlussfolgerung: Unsere Ergebnisse zeigen, dass weder Linksherzinsuffizienz oder die absolute Thrombuslast Hauptfaktoren für eine Infarktbildung sind; diese scheint hingegen im Wesentlichen durch die weit periphere Lage des thromboembolischen Verschlusses determiniert zu werden.

Kernaussagen:

• Die weit periphere Lage des thromboembolischen Verschlusses ist der wichtigste pathophysiologischen Faktor in der Infarktentwicklung.

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