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(Chest. 2005;127:1178-1183.)
© 2005 American College of Chest Physicians

Causes and Presenting Features of Pulmonary Infarctions in 43 Cases Identified by Surgical Lung Biopsy*

Joseph G. Parambil, MD; C. Dilara Savci, MD; Henry D. Tazelaar, MD, FCCP and Jay H. Ryu, MD, FCCP

* From the Division of Pulmonary and Critical Care Medicine, and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN.

Correspondence to: Jay H. Ryu, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: ryu.jay{at}mayo.edu


   Abstract
TOP
 Abstract
Introduction
 Materials and Methods
 Results
 Discussion
 References
 
Background: Although pulmonary infarction is usually associated with pulmonary thromboembolism, it can occur with other disorders such as vasculitis, angioinvasive infections, sickle-cell disease, tumor embolism, and pulmonary torsion.

Study objective: To identify causes and presenting features of pulmonary infarctions diagnosed by surgical biopsy in a consecutive series of patients encountered at a single institution.

Design: Retrospective review.

Setting: Tertiary care, referral medical center.

Patients: Forty-three patients with pulmonary infarction identified on surgical lung biopsy over a period of 7 years, January 1996 through December 2002.

Results: The median age of these 43 patients was 55 years (range, 22 to 85 years); 17 patients (40%) were women, and 26 patients (60%) were men. Thirty-five patients (81%) had a smoking history. Twenty-eight patients (65%) presented with solitary or multiple lung nodules/masses of undetermined etiology. The underlying cause was identifiable in 31 cases (72%) based on a review of clinical, laboratory, radiologic, and histopathologic data. The two most common causes were pulmonary thromboembolism (18 cases, 42%) and pulmonary infections (5 cases, 12%). Thromboembolic pulmonary infarctions typically presented as solitary or multiple nodules located in the subpleural regions. Other causes included diffuse alveolar damage in two cases (5%), pulmonary torsion in two cases (5%), and one case each of lung cancer, amyloidosis, embolotherapy, and catheter embolism. In 12 cases (28%), the underlying cause was not directly identifiable but was probably due to previous pulmonary thromboembolism.

Conclusion: We conclude that although pulmonary thromboembolism is the most common cause of pulmonary infarction identified by surgical lung biopsy, a variety of other causes are clinically encountered, including infections, inflammatory or infiltrative lung diseases, pulmonary torsion, malignancy, and nonthrombotic embolism. Pulmonary infarction should be considered in the differential diagnosis of peripheral lung nodules or masses.

Key Words: lung biopsy • lung torsion • pulmonary embolism • pulmonary infarction


   Introduction
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 Abstract
 Introduction
Materials and Methods
 Results
 Discussion
 References
 
Pulmonary infarction usually results from pulmonary thromboembolism.1 However, it can also occur in association with other disorders including vasculitis, infections, pulmonary torsion, sickle-cell disease, and various nonthrombotic causes of pulmonary embolism.23456 Radiologically, pulmonary infarctions typically present as peripheral wedge-shaped parenchymal opacities, particularly when associated with thromboembolism.7 However, the radiologic appearance of pulmonary infarction is variable partly depending on the underlying cause and temporal evolution of the lesion.89 To assess the spectrum of causes of pulmonary infarctions and the associated clinical and radiologic presentations, we identified a consecutive series of patients whose surgical lung biopsy demonstrated pulmonary infarction to assess the underlying causes, as well as the presenting epidemiologic, clinical, and radiologic features.


   Materials and Methods
TOP
 Abstract
 Introduction
 Materials and Methods
Results
 Discussion
 References
 
Patients with pulmonary infarctions diagnosed on surgical lung biopsy at Mayo Medical Center, Rochester, MN, from January 1, 1996, to December 31, 2002, were identified by a computer-assisted search of medical records. We examined the medical records and imaging studies of these patients to gather data regarding their presenting epidemiologic, clinical, and radiologic features, as well as their clinical course. The underlying cause of pulmonary infarction was determined by review of the clinical evaluation, radiologic findings, microbiologic results, and histopathologic findings.

Surgically resected specimens were obtained by thoracotomy in 22 patients (51%) and video-assisted thoracoscopy in 21 patients (49%). Wedge resection was performed in 39 patients (85%), and lobectomy was performed in 4 patients (15%).

Radiologically, a lung nodule was defined as a relatively round and circumscribed parenchymal opacity that was ≤ 3 cm in diameter, whereas a lung mass was defined as an opacity that was > 3 cm in diameter.10 Other radiologic presentations were categorized as focal or bilateral infiltrates, cavity, or pleural effusion.

Thromboembolic infarction was diagnosed by the histologic presence of organizing thrombi adjacent to foci of necrosis within an area of hemorrhage, affecting the alveolar walls, bronchioles, and vessels. In the absence of organizing thrombi adjacent to the focus of necrosis, thromboembolic infarction was considered the diagnosis if postoperative imaging study findings (CT angiography of the thorax or ultrasound imaging of the venous system) were positive. Infection and septic embolism as causes were established by histologic evidence of pulmonary infarction modified by an intense neutrophilic inflammatory reaction and by identifying an organism through microbial culture of the lung biopsy specimen. The diagnoses of diffuse alveolar damage, lung cancer, and amyloidosis were based on characteristic histologic findings and the absence of any other identifiable cause for pulmonary infarction. The diagnosis of pulmonary torsion was based on characteristic radiologic and intraoperative findings. Embolotherapy and foreign body embolism as causes of pulmonary infarction were diagnosed from the appropriate clinical context with consistent radiologic and histopathologic findings.

The institutional review board of Mayo Foundation approved this study. Patients who did not authorize the use of their medical records for research were excluded from this study.


   Results
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
Discussion
 References
 
Forty-three patients had histopathologic findings of pulmonary infarction on surgical lung biopsy during the 7-year study period. The median age of these patients was 55 years (range, 22 to 85 years); 17 patients (40%) were women, while 26 patients (60%) were men (Table 1 ). Thirty-five patients (81%) had a smoking history. Fifteen patients (35%) presented with respiratory symptoms, mainly dyspnea, while the remaining 28 patients (65%) had no relevant respiratory symptoms and presented with abnormal findings on chest radiography and/or CT. Among these 28 patients without respiratory symptoms, 17 patients (40%) carried a diagnosis of an underlying malignancy. In 10 patients (23%), the malignancy was current; in the remaining 7 patients (16%), the malignancy had been previously treated. Nine other patients (21%) were undergoing reassessment of a preexisting cardiopulmonary disease, and the remaining two patients (4%) were being evaluated for fatigue.


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  		Table 1.. Epidemiologic and Clinical Aspects of 43 Study Subjects*

 
There was a history of documented venous thromboembolism in six cases (14%), with the event occurring 7 weeks to 8 years prior to presentation (median, 28 months). Six patients (14%) were receiving oral anticoagulant therapy at the time of evaluation: four patients for chronic atrial fibrillation and two patients for venous thromboembolism occurring 3 months and 3 weeks before surgical biopsy, respectively.

Preoperatively, pulmonary embolism was considered as a potential cause of the radiologic abnormalities in only two patients (5%). In one patient, surgical lung biopsy was performed despite ultrasound evidence of venous thrombosis because a transthoracic needle aspiration biopsy from a solitary lung nodule revealed atypical cells. The other patient had hemoptysis associated with a solitary lung mass, and preoperative ultrasound examination results of the lower extremities were negative for deep venous thrombosis.

Indications for surgical lung biopsy (Table 2 ) most commonly included a solitary lung nodule or mass (19 cases) and multiple nodules/masses (9 cases) of undetermined nature. Other indications included progressive bilateral lung infiltrates (four cases), a focal infiltrate (two cases), suspected torsion (two cases), persistent pleural effusions (two cases), a cavitary lesion (one case), empyema (one case), thoracotomy wound infection (one case), lung cancer (one case), and embolized IV catheter fragment (one case).


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  		Table 2.. Indications for Thoracic Surgery

 
Of the 28 cases presenting as solitary or multiple nodules/masses, the diameter of the lesions ranged from 1 to 6 cm. Eccentric calcification was noted within the lesion in two cases (7%). In 25 of these cases (89%), nodule/mass lesions were seen in the subpleural (abutting the pleura) location (Fig 1 ).



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  		Figure 1.. A 2.5-cm nodule (arrow) is seen in the subpleural region of the right lung base of a 45-year-old man with no symptoms. This lesion was shown to be a thromboembolic infarction on surgical lung biopsy.

 
The lung biopsy in each patient revealed histopathologic features of pulmonary infarction. The cause of thromboembolism was identifiable in 31 cases (72%) based on review of clinical, laboratory, radiologic, and histopathologic data (Table 3 ). The most common cause of pulmonary infarction in our patients was thromboembolism, accounting for 18 cases (42%). In 11 of these patients, organizing thrombi were found adjacent to the zone of infarction (Fig 2 ). Seven other patients with pulmonary thromboembolism had evidence of venous thromboembolism demonstrated on postoperative CT scan of the chest (three cases) or ultrasound examination of the veins (lower extremity in two cases and upper extremity in two cases) with no other apparent cause for pulmonary infarction. Of 18 patients with thromboembolic pulmonary infarctions, 11 patients presented with solitary nodule/mass, 4 patients presented with multiple nodules/masses, 2 patients presented with focal infiltrate or cavity, and 1 patient presented with pleural effusion. Subpleural location of the nodule or infiltrate was noted in 15 of 17 patients presenting with parenchymal opacities.


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  		Table 3.. Causes of Pulmonary Infarction in 43 Patients

 


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  		Figure 2.. Photomicrograph of a thromboembolic infarction. A wedge-shaped zone of infarction with lung parenchyma undergoing coagulative necrosis (*) is surrounded by hemorrhage. An arrow highlights a pulmonary artery virtually occluded by an organizing thrombus (hematoxylin-eosin, original x 40).

 
Nonthromboembolic causes for pulmonary infarction were identifiable in 13 cases (30%) [Table 3]. These causes included infections in five cases (12%), diffuse alveolar damage in two cases (5%), pulmonary torsion in two cases (5%), and one case each of lung cancer, amyloidosis, embolotherapy, and catheter embolism. Infectious causes included one case each of cytomegalovirus pneumonia in a bone marrow transplant recipient, Aspergillus fumigatus pneumonia in a patient with T-cell leukemia, postpneumonic empyema due to Staphylococcus aureus, postthoracotomy (for removal of a broncholith) pneumonia due to Pseudomonas aeruginosa, and septic embolism complicating S aureus endocarditis. One of the two cases of diffuse alveolar damage was likely due to amiodarone pulmonary toxicity, while the cause was unknown in the other case. Two cases of pulmonary torsion were both suspected preoperatively based on radiologic findings (Fig 3 ) and occurred after right upper lobectomy for cancer resection. These two patients underwent subsequent right middle lobectomy and completion pneumonectomy 5 days and 10 days after their initial surgery, respectively. In one patient, non-small cell lung cancer located at the hilum was causing vascular compromise. Another case involved primary amyloidosis with extensive pulmonary infiltration and associated infarctions. One patient underwent a lobectomy for persistent hemoptysis, and infarction from prior bronchial artery embolotherapy was noted in the resected specimen. One remaining patient underwent a lobectomy for pulmonary infarction resulting from embolization of a fragment of peripherally inserted central venous catheter. Two patients with diffuse alveolar damage along with patients who had amyloidosis and invasive aspergillosis (one each) accounted for those presenting with bilateral lung infiltrates. The remaining nine patients presented with multiple nodules, focal infiltrate, or pleural effusion.



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  		Figure 3.. CT of the chest performed 9 days after right upper lobectomy for non-small cell lung cancer in a 61-year-old woman demonstrates narrowing (arrow) of the right pulmonary artery and consolidative infiltrates involving the remaining right lung. Pulmonary torsion with hemorrhagic infarction of the remaining right lung was confirmed at the time of repeat thoracotomy on the day following this scan. Completion pneumonectomy was performed.

 
In 12 cases (28%), the underlying cause was not directly identifiable but was probably due to a previous episode of pulmonary thromboembolism. Eleven of these patients presented with solitary (8 patients) or multiple nodules/masses (3 patients). In all of these 11 cases, CT scan of the chest demonstrated the lesions to be subpleural in location, suggestive of thromboembolic origin. The remaining patient presented with a focal infiltrate.

Mean duration of follow-up was 16 months (range, 8 days to 6 years). Two patients (5%) died within 7 days of surgery due to underlying disease that included ARDS and cytomegalovirus pneumonia. During the remainder of the follow-up period, 15 additional patients (35%) died. The cause of death was identified in 14 of these patients (93%) and included progressive malignancy in six cases (including two cases of colon cancer, two cases of non-Hodgkin lymphoma, one case each of ovarian cancer and esophageal cancer), recurrent pulmonary embolism in two cases, ARDS in two cases, sepsis in two cases (angioinvasive pulmonary aspergillosis and S aureus), and one case each of congestive heart failure and acute renal failure.


   Discussion
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
References
 
Pulmonary infarction usually results from pulmonary thromboembolism but has also been reported in many other disorders. Many of these associations have been reported as single cases, making it difficult to determine the frequency of underlying causes for pulmonary infarction. To our knowledge, this is the first study to determine the etiology of pulmonary infarction in a consecutive series of patients in whom the histopathologic diagnosis was established.

Our data confirm that pulmonary thromboembolism is the most common cause of pulmonary infarction. However, one third of our cohort had pulmonary infarctions resulting from a variety of nonthromboembolic causes. These included pulmonary infections, diffuse alveolar damage, pulmonary torsion, lung cancer, amyloidosis, bronchial artery embolization therapy, and IV catheter embolization. Pulmonary infections, particularly angioinvasive fungal infections such as aspergillosis, are well known to cause pulmonary infarction.1112 Diffuse alveolar damage occurring in patients with ARDS is associated with activation of the blood coagulation system and thrombosis in the pulmonary vasculature.1314 Lung torsion is a rare condition that is generally associated with thoracic surgery or trauma and results in hemorrhagic infarction.1516 Management of this condition usually requires surgical resection or fixation of the involved lung. Lung cancer can invade pulmonary arteries or veins causing vascular obstruction and subsequent pulmonary infarction.171819 Although the occurrence of pulmonary infarction caused by lung cancer has been rare in our experience (< 1% of resected lung cancer specimens), Hanbury and colleagues20 reported a 10% incidence of pulmonary infarctions seen in a series of 100 cases of pneumonectomy performed for lung cancer. One half of their cases of pulmonary infarction appeared to be directly related to the lung cancer, ie, caused by tumor invasion or compression of adjacent pulmonary vessels.

To our knowledge, amyloidosis as a cause of pulmonary infarction has not been previously reported. It has, however, been associated with infarction in other organs, specifically the heart.2122 In our patient with primary systemic amyloidosis, the lung biopsy demonstrated extensive pulmonary amyloidosis with associated organizing hemorrhage and infarctions. Pulmonary infarction is a recognized complication of pulmonary artery or bronchial artery embolization therapy.23 Various nonthrombotic emboli such as tumor and foreign bodies may also cause pulmonary infarction.624 One of our patients had pulmonary infarction resulting from embolization of a fragment of an IV catheter. Our case series did not include any patient with pulmonary infarction resulting from vasculitis,225 Swan-Ganz catheter use,2627 or sickle-cell disease.2829

Only approximately 10% of pulmonary emboli cause parenchymal infarction.3031 Pulmonary infarction is uncommon because the pulmonary parenchyma has three potential sources of oxygen: the pulmonary arteries, the bronchial arteries, and the airways. Thus, infarction from pulmonary embolism tends to occur in subjects with preexisting cardiopulmonary disease.1 Radiologically, the appearance of pulmonary infarction is described as a shallow hump-shaped lesion (alternatively referred to as a Hampton hump) with its base applied to a pleural surface.7893233 However, pulmonary infarctions may have a variety of shapes and sizes due to surrounding hemorrhage and its temporal evolution.89 Pulmonary infarctions generally take several months to resolve and may leave behind a linear or nodular scar.89

There are potential biases that need to be addressed in assessing the spectrum of causes for pulmonary infarctions in this cohort of patients. Since the diagnosis of pulmonary infarction was based on a surgical lung biopsy, thromboembolic infarctions are likely underrepresented when compared to their actual incidence. Most infarctions resulting from pulmonary thromboembolism are diagnosed based on the results of clinical and radiologic evaluation without the need for lung biopsy. Similarly, infection, vasculitis, and other recognized causes of pulmonary infarction usually do not require lung biopsy for diagnosis.

Nonetheless, our data provide new insights into the spectrum of causes for pulmonary infarctions and the associated clinical and radiologic presentation. The majority of these patients underwent a surgical lung biopsy because of suspected lung cancer based on the radiologic appearance of focal opacities. It is of interest to note that the majority of these patients presented with solitary or multiple nodules/masses, and most of these lesions were located in the subpleural zones of the lungs. Thus, the possibility of pulmonary infarction should be considered in the evaluation of peripheral lung nodules or masses of undetermined nature. Pulmonary infarctions can be associated with other features suggestive of malignancy, including atypical cells appearing in respiratory specimens,343536 a positive contrast-enhancement CT study,37 as well as positive uptake on positron emission tomography.37

We conclude that although pulmonary thromboembolism is the most common identifiable cause, a variety of nonthromboembolic disorders are clinically encountered as causes of pulmonary infarctions as diagnosed on surgical lung biopsy. Pulmonary infarctions may present as peripheral pulmonary nodules or masses suspicious for lung cancer. In some of these cases, surgical lung biopsy may be required for definitive diagnosis of pulmonary infarction.


   Footnotes
 
Funding was provided by the Mayo Foundation.

Received for publication July 12, 2004. Accepted for publication September 30, 2004.


   References
TOP
 Abstract
 Introduction
 Materials and Methods
 Results
 Discussion
 References
 

  1. Tsao, MS, Schraufnagel, D, Wang, NS (1982) Pathogenesis of pulmonary infarction. Am J Med 72,599-606[CrossRef][ISI][Medline]
  2. Erkan, F, Gül, A, Tasali, E Pulmonary manifestations of Behçet’s disease. Thorax 2001;56,572-578[Free Full Text]
  3. Libshitz, HI, Pagani, JJ Aspergillosis and mucormycosis: two types of opportunistic fungal pneumonia. Radiology 1981;140,301-306[Abstract/Free Full Text]
  4. Kucich, VA, Villarreal, JR, Schwartz, DB Left upper lobe torsion following lower lobe resection: early recognition of a rare complication. Chest 1989;95,1146-1147[Abstract/Free Full Text]
  5. Knight, J, Murphy, TM, Browning, I The lung in sickle cell disease. Pediatr Pulmonol 1999;28,205-216[CrossRef][ISI][Medline]
  6. Rossi, SE, Goodman, PC, Franquet, T Nonthrombotic pulmonary emboli. AJR Am J Roentgenol 2000;174,1499-1508[Free Full Text]
  7. Balakrishnan, J, Meziane, MA, Siegelman, SS, et al Pulmonary infarction: CT appearance with pathologic correlation. J Comput Assist Tomogr 1989;13,941-945[ISI][Medline]
  8. Greaves, SM, Hart, EM, Aberle, DR CT of pulmonary thromboembolism. Semin US CT MRI 1997;18,323-337
  9. Johnson, PT, Wechsler, RJ, Salazar, AM, et al Spiral CT of acute pulmonary thromboembolism: evaluation of pleuroparenchymal abnormalities. J Comput Assist Tomogr 1999;23,369-373[CrossRef][ISI][Medline]
  10. Tan, BB, Flaherty, KR, Kazerooni, EZ, et al The solitary pulmonary nodule. Chest 2003;123,89S-96S
  11. Franquet, T, Muller, NL, Gimenez, A, et al Spectrum of pulmonary aspergillosis: histologic, clinical, and radiologic findings. Radiographics 2001;21,825-837[Abstract/Free Full Text]
  12. Libshitz, HI, Pagani, JJ Aspergillosis and mucormycosis: two types of opportunistic fungal pneumonia. Radiology 1981;140,301-306[Abstract/Free Full Text]
  13. Idell, S Adult respiratory distress syndrome: do selective anticoagulants help? Am J Respir Med 2002;1,383-391[Medline]
  14. Greene, R, Lind, S, Jantsch, H, et al Pulmonary vascular obstruction in severe ARDS: angiographic alterations after i.v. fibrinolytic therapy. AJR Am J Roentgenol 1987;148,501-508[Abstract/Free Full Text]
  15. Schamaun, M Postoperative pulmonary torsion: report of a case and survey of the literature including spontaneous and posttraumatic torsion. Thorac Cardiovasc Surg 1994;42,116-121[ISI][Medline]
  16. Wong, PS, Goldstraw, P Pulmonary torsion: a questionnaire survey and a survey of the literature. Ann Thorac Surg 1992;54,286-288[Abstract]
  17. Nomori, H, Horio, H, Morinaga, S, et al Multiple pulmonary infarctions associated with lung cancer. Jpn J Clin Oncol 2000;30,40-42[Abstract/Free Full Text]
  18. Edmondstone, WM Flitting radiographic shadows: an unusual presentation of cancer in the lungs. Thorax 1998;53,906-908[Abstract/Free Full Text]
  19. Marriott, AE, Weisbrod, G Bronchogenic carcinoma associated with pulmonary infarction. Radiology 1982;145,593-597[Abstract/Free Full Text]
  20. Hanbury, WJ, Cureton, RJR, Simon, G Pulmonary infarcts associated with bronchogenic carcinoma. Thorax 1954;9,304-312[ISI][Medline]
  21. Miani, D, Rocco, M, Alberti, E, et al Amyloidosis of epicardial and intramural coronary arteries as an unusual cause of myocardial infarction and refractory angina pectoris. Ital Heart J 2002;3,479-482[Medline]
  22. Kotani, N, Hashimoto, H, Muraoka, M, et al Fatal myocardial infarction in four patients with cardiac amyloidosis. Anesthesiology 2000;92,873-875[CrossRef][ISI][Medline]
  23. Remy-Jardin, M, Wattinne, L, Remy, J Transcatheter occlusion of pulmonary arterial circulation and collateral supply: failures, incidents, and complications. Radiology 1991;180,699-705[Abstract/Free Full Text]
  24. Kim, AE, Haramati, LB, Janus, D, et al Pulmonary tumor embolism presenting as infarcts on computed tomography. J Thorac Imag 1999;14,135-137[ISI][Medline]
  25. Ferretti, G, Defaye, P, Thony, F, et al Initial isolated Takayasu’s arteritis of the right pulmonary artery: MR appearance. Eur Radiol 1996;6,429-432[ISI][Medline]
  26. Lange, HW, Galliani, CA, Edwards, JE Local complications associated with indwelling Swan-Ganz catheters: autopsy study of 36 cases. Am J Cardiol 1983;52,1108-1111[CrossRef][ISI][Medline]
  27. Shin, MS, Reeves, RC, Ho, KJ Computed tomographic detection of cavitary lung lesion complicating use of flow-directed balloon-tipped catheter. Chest 1989;96,432-434[Abstract/Free Full Text]
  28. Rucknagel, DL, Kalinyak, KA, Gelfand, MJ Rib infarcts and acute chest syndrome in sickle cell diseases. Lancet 1991;337,831-833[CrossRef][ISI][Medline]
  29. Israel, RH, Salipante, JS Pulmonary infarction in sickle cell trait. Am J Med 1979;66,867-869[CrossRef][ISI][Medline]
  30. Moser, KM Venous thromboembolism. Am Rev Respir Dis 1990;141,235-249[ISI][Medline]
  31. Morgenthaler, TI, Ryu, JH, Utz, JP Cavitary pulmonary infarct in immunocompromised hosts. Mayo Clin Proc 1995;70,66-68[ISI][Medline]
  32. Hampton, AO, Castleman, B Correlation of post-mortem chest teleroentgenograms with autopsy findings with special reference to pulmonary embolism and infarctions. Am J Roentgen 1940;43,305-326
  33. Talbot, S, Worthington, BS, Roebuck, EJ Radiographic signs of pulmonary embolism and infarction. Thorax 1978;28,198-203
  34. Scoggins, WG, Sith, RH, Frable, WJ, et al False-positive cytological diagnosis of lung carcinoma in patients with pulmonary infarcts. Ann Thorac Surg 1977;24,474-480[Abstract]
  35. Bewtra, C, Dewan, N, O’Donohue, WJ, Jr Exfoliative sputum cytology in pulmonary embolism. Acta Cytol 1983;27,489-496[ISI][Medline]
  36. Lawther, RE, Graham, AN, McCluggage, WG, et al Pulmonary infarct cytologically mimicking adenocarcinoma of the lung. Ann Thorac Surg 2002;73,1964-1965[Abstract/Free Full Text]
  37. George, CJ, Tazelaar, HD, Swensen, SJ, et al Pulmonary infarctions mimicking lung cancer. Mayo Clin Proc 2004;79,895-898[ISI][Medline]




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