An unusual presentation of pulmonary embolism leading to infarction, cavitation, abscess formation and bronchopleural fistulation.
We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.
['Teng|Eva|E|', 'Bennett|Luke|L|', 'Morelli|Tommaso|T|', 'Banerjee|Anindo|A|']
D000038:Abscess D019980:Amoxicillin-Potassium Clavulanate Combination D000900:Anti-Bacterial Agents D001983:Bronchial Fistula D018450:Disease Progression D004359:Drug Therapy, Combination D006801:Humans D007238:Infarction D008297:Male D000077731:Meropenem D008795:Metronidazole D008875:Middle Aged D010995:Pleural Diseases D011014:Pneumonia D011655:Pulmonary Embolism D013902:Radiography, Thoracic D000069552:Rivaroxaban D013845:Thienamycins D016896:Treatment Outcome
pulmonary embolism pneumonia (respiratory medicine)