PMC5725153_01
Comparison between chest radiograph images at the time of first admission (A) and at the time of the second admission after completion of the antibiotic cycle (B).
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On the chest radiograph (CXR) of admission, an image of alveolar consolidation was found in the left upper lobe (LUL) [Fig. 1a]. Complementary tests performed on emergency room showed: Laboratory test proved normal white blood cell count (9.51 x 109/l), normal platelet count (242 x 109/l) normal value of hemoglobin (15.9 g/dl), not elevated C reactive protein, 4.8 mg/dl (0.0-5.0 mg/dl), haemostasis with INR in rank and negative autoimmunity; electrocardiogram evidenced atrial fibrillation with ventricular response at 80 bpm without alterations of repolarization; CXR showed increased size of the LUL consolidation, with no associated pleural effusion, and no alterations in the mediastinum and pulmonary hilias [Fig. 1b].
Thoracic angiography (A and B) showing extensive consolidation in the anterior segment of the LUL with a high-density central component, corresponding to lung infarction, and a low-density periphery due to hemorrhage; Cardiac CT (C, D and E) after injection of intravenous contrast in the late phase with filling defect of the left superior lobar vein (white arrow) and its subsegmental branches.
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After these findings, a diagnosis of PVT and secondary venous infarction was made [Fig. 2] and we decided to switch anticoagulation with heparin at therapeutic doses.