Pulmonary infarction (PI) often mimics lobar pneumonia. A 23-year-old man with prostatitis presented with pleuritic pain and hemoptysis. Despite high inflammatory markers, consolidation was refractory to antibiotic treatment. Retrospectively, the initial opacities represented the hyperacute hemorrhagic phase of PI. Thoracentesis revealed bloody effusion, and contrast-enhanced computed tomography (CECT) confirmed pulmonary thromboembolism with characteristic "central lucencies." Anticoagulation therapy led to his recovery. PI should be considered in young patients with refractory pneumonia. Bloody effusion and central lucencies are critical diagnostic clues. Combined localized infection and transient stressors (dehydration/immobility) can trigger venous thromboembolism, even in the absence of hereditary thrombophilia. Early CECT can prevent unnecessary invasive procedures.
Kawamura et al. (Thu,) studied this question.