Pulmonary infarction secondary to pulmonary embolism: An evolving paradigm. Issue 9 (25th March 2018)

• Record Type: Journal Article
• Authors: Islam, Marjan; Filopei, Jason; Frank, Matthew; Ramesh, Navitha; Verzosa, Stacey; Ehrlich, Madeline; Bondarsky, Eric; Miller, Albert; Steiger, David
• Is Part Of: Respirology. Volume 23:Issue 9(2018)
• Page Start: 866
• Page End: 872
• Publication Date: 2018-03-25
• Subjects: emphysema -- inflammation -- pulmonary circulation -- pulmonary embolism -- pulmonary hypertension; Respiratory organs -- Diseases -- Periodicals; Respiratory organs -- Periodicals; 612.2
• DOI: 10.1111/resp.13299
• Languages: English
• ISSNs: 1323-7799

Abstract

ABSTRACT: Background and objective: Pulmonary infarction (PI) from pulmonary embolism (PE) remains an entity of unclear aetiology. PI has been thought to occur in elderly patients with cardiopulmonary disease. We hypothesize younger patients without cardiopulmonary comorbidities are at highest risk. Our study aims to characterize PI clinically and radiographically, determine associated risk factors and determine their clinical significance. Methods: We conducted a single‐centre retrospective review of 367 consecutive patients with PE. Clinical and radiographic data were compared between patients with and without PI using chi‐square and F‐tests. Univariate and multivariate analyses were performed to evaluate risk factors for PI. Results: PI occurred in 62 of 367 patients with acute PE (16.9%). Patients with PI were significantly younger (48 ± 20.3 vs 59.6 ± 17.2 years, P < 0.01), with lower pulmonary embolism severity index (PESI) scores (73.7 ± 38.1 vs 91.9 ± 37.5 years, P < 0.01) and endorsed chest pain with significantly higher frequency (65% vs 39%, P < 0.01). There was no significant difference in other clinical symptoms, hospital length of stay or mortality between groups. Presence of radiographic cardiopulmonary disease was significantly lower in patients with PI (emphysema: 5% vs 22%, P = <0.01; aortic atherosclerosis: 23% vs 43%, P = <0.01). In multivariate analysis, age ≤33 (OR 3.5 CI: 1.37–8.95, P < 0.01), chest pain (OR 2.15 CI: 1.15–4.00, P = 0.02) and pleural effusion (OR 2.18 CI: 1.08–4.41, P = 0.03) increased PI risk and presence of emphysema decreased risk (OR 0.21 CI: 0.06–0.70, P = 0.01). Conclusion: Younger patients without cardiopulmonary comorbidities are at highest risk of PI. Chest pain and pleural effusion significantly increased risk of PI while presence of radiographic emphysema reduced risk. Abstract : Pulmonary infarction during acute pulmonary embolism is proposed to occur predominantly in elderly heart patients. We found that younger individuals without cardiopulmonary disease were more likely to develop pulmonary infarction during pulmonary embolism and hypothesized that regional hypoxia from chronic cardiopulmonary disease promotes pulmonary collateral circulation, offering protection from pulmonary infarction. See related Editorial