ACUTE PULMONARY EMBOLISM COMPLICATED BY PARENCHYMAL CAVITATION AND STERILE NECROSIS

TOPIC: Pulmonary Vascular Disease TYPE: Fellow Case Reports INTRODUCTION: embolism (PE) can lead to infarction in 10% of cases, but cavitation and necrosis are rare. We present a case PE-associated lung complicated by rapid development loculated effusions. CASE PRESENTATION: A 25-year-old previously healthy male presented with 3 days worsening dyspnea. His initial exam was notable for 38.9 °C fever tachycardia. chest CT showed acute PEs involving the right main pulmonary artery that extended into segmental subsegmental arteries. He also had lower lobe (RLL) wedge-shaped peripheral cavitary thought represent infarct, small pleural effusion. Echocardiogram normal biventricular function, thrombectomy not pursued. The patient started on therapeutic heparin ampicillin/sulbactam. On hospital day 4, his x-ray point-of-care ultrasound revealed markedly increased right-sided Thoracentesis yielded 100mL serosanguinous fluid 4,500 cells/microL WBC, 93% neutrophils, pH 7.08, glucose <4 mg/dL, LDH 3,456 IU/L, negative gram stain culture. repeat RLL as well effusion foci air. have infarct secondary PEs, subsequent inflammatory hypercoagulable workup returned negative. DISCUSSION: given dual blood supply lungs making tissues less susceptible infarction. infarctions occur PE when bronchial circulation cannot compensate provide adequate area. Cavitation develops 4-7% cases Risk factors include size >4cm, older age, chronic disease, heart failure. may be result sterile or infection. Cavitations earlier infected compared bland mean 18 versus 28 one study, respectively.PEs due cytokine release vessel permeability, pressure parietal pleura capillaries. Pleural findings vary widely more often exudative than transudative. In this case, we suspect patient's led causing significant response, resulting rapidly enlarging CONCLUSIONS: Large infarcts caused develop cavitations reflect Early follow-up imaging should considered patients large infarcts. REFERENCE #1: Emerling A, Cook J. Infarction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 23, 2020. #2: Light RW. emboli. Curr Opin Pulm Med. 2001;7(4):198-201. doi:10.1097/00063198-200107000-00006 #3: Rajagopala S, Devaraj U, D'Souza G. Infected cavitating Respir Care. 2011;56(5):707-709. doi:10.4187/respcare.00828 DISCLOSURES: Advisory Board relationship Insmed Please note: $1001 - $5000 Ashwin Basavaraj, source=Web Response, value=Honoraria Consultant Hill-Rom value=Consulting fee Committee Member Zambon october 2020-current Added 04/29/2021 Removed Response zambon 10/1/2020-current Dymedso 01/01/2021-current No relevant relationships Karthik Bharadwaj, Amie Kent, Benjamin Kwok, Vivek Murthy, Karen Yang,