Internal Medicine

Pulmonary infarction (PI)

Lung tissue infarction due to thrombus lodging in segmental and subsegmental vessels usually in the setting of pulmonary embolism (PE).

Lung tissue infarction due to thrombus lodging in segmental and subsegmental vessels usually in the setting of pulmonary embolism (PE).


Hampton and Castleman provided the first accurate description of the radiologic appearance of pulmonary infarction. In their series of 370 patients with autopsy-proven pulmonary embolism (PE), pulmonary infarction was found in nearly 70%. The frequency of infarction was the highest among the patients who came to death with a history of longstanding heart failure. Ever since then, pulmonary venous hypertension, secondary to heart failure, has been regarded as a predisposing risk factor for pulmonary infarction in the setting of acute PE. Elevated pulmonary venous pressure is believed to hinder collateral blood flow via broncho-pulmonary anastomoses distal to embolized regions.


Pulmonary embolism (PE) (M/C)

PI occurs in nearly ⅓ of patients with PE, usually a small PE

Other causes:

  • Infection, malignancy, surgical iatrogenesis, amyloidosis, sickle cell disease, vasculitis

Risk factors:

  • Smoking
  • Pulmonary venous hypertension
  • Heart failure

Clinical features

  • Dyspnea
  • Chest pain
  • Swelling/pain in unilateral lower extremity
  • Fever
  • Hemoptysis



  • Hampton’s hump (wedge-shaped consolidation at the lung periphery)
  • Westermark’s sign (radiographic oligemia or increased lucency)
  • Fleischer sign (prominent pulmonary artery)
  • Atelectasis or focal consolidation

CT scan:

  • Feeding vessel or “vessel sign” with central lucency and a semicircular shape
  • No air bronchogram
Examples of pulmonary infarction. A, 47-year-old man with infarction in right lower lobe. B, 48-year-old woman with multiple infarcts in right lower lobe. C, 57-year-old man with infarction in right lower lobe. D: 29-year-old woman with bilateral, multiple infarcts in right and left lower lobes. In all images, infarcts are arranged along the visceral pleura and have a cushion-like of hemispherical shape. Focal hyperlucencies within the infarction are evident. | Miniati, M., Bottai, M., Ciccotosto, C., Roberto, L., & Monti, S. (2015). Predictors of Pulmonary Infarction. Medicine, 94(41), e1488.


In addition to supportive management, treatment is guided by the underlying condition that has led to the PI.

Anticoagulant therapy:

  • IV Heparin or LMW heparin (inpatient management)
  • Warfarin or other oral-anticoagulants (outpatient management)

In patients with hemodynamic instability due to a sub-massive or massive PE:

  • Catheter-based fibrinolytics
  • Systemic fibrinolytics
  • Surgical interventions

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