PMC7269527_01
Initial non-enhanced axial chest CT image (A) shows few scattered peripheral ground-glass opacities in both the lungs. Non-enhanced axial chest CT image obtained 14 days later (B) indicates an increased extent of the ground-glass opacities and development of consolidation, especially in the posterior periphery of the right lower lobe. A new right-sided laminar pleural effusion (black arrowhead) can be observed. Note the difference in heart volume between images A and B (the heart volume is greater in image B, although within normal limits). CT pulmonary angiography images in the coronal-oblique plane with maximum intensity projection (C) and sagittal plane (D) show acute emboli (white arrows) in the sub-segmental arterial branches of the posterior basal segment of the right lower lobe. CT pulmonary angiography image (lung window) in the axial plane (E) depicts peripheral opacity with features compatible with pulmonary infarction (reversed halo sign with internal reticulation and low-attenuation areas, black arrow) in the posterior basal segment of the right lower lobe. Dual-energy CT color-coded iodine "perfusion" map in the coronal plane (F) suggesting focal iodine defect (white arrowhead) only in the area of pulmonary infarction in the right lower lobe.
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The patient underwent a non-enhanced chest computed tomography (CT) scan that revealed few scattered ground-glass opacities in both the lungs, with a predominantly peripheral distribution (Figure 1A). Repeat non-enhanced chest CT showed an increase in the extent of bilateral and multilobar lung involvement by predominantly peripheral multifocal opacities, along with consolidation, and development of sub-pleural lines and newer ground-glass opacities (Figure 1B). It showed filling defects in sub-segmental arterial branches of the posterior basal segment of the right lower lobe, consistent with acute PE (Figure 1C and Figure 1D). Additionally, the peripheral lung opacity with reversed halo sign and central lucencies, compatible with pulmonary infarction, could be detected in this examination (Figure 1E). Dual-energy CT color-coded iodine "perfusion" map revealed only a focal iodine defect in the posterior basal segment of the right lower lobe, where the pulmonary infarction was detected (Figure 1F).