Presentation
COPD and congestive heart failure (ejection fraction:25 %). Dyspnea and bilateral lower leg edema. Elevated CRP and WBC.
Patient Data
Wedge-shaped opacities in the right midle and lower lobes. Small opacification in lower part of left upper lobe.
Request for CT due to persistent symptoms despite adequate treatment. Hemoptysis.
Referring physician asks for malignancy and/or pneumonia.
Bilateral pulmonary embolism to middle, right lower and left upper lobe arteries. Right atrial dilation. Wedge-shaped "bubbly" opacities due to pulmonary infarction.
Case Discussion
Lobar opacities may be non-specific but in this case with elevated CRP and WBC likely to be interpreted as pneumonia on the plain film study.
In acute pulmonary embolism, it is more likely to not see any opacities in the lung parenchyma.
CT examination above was performed in arterial phase because of the question of malignancy and/or pneumonia. Luckily there was good contrast enhancement in the pulmonary arteries which was crucial to achieve correct diagnosis.
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