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(a) MRI (diffusion-weighted image) showing right corona radiate infarction. (b) MR angiography (MRA) reveals right middle cerebral artery (MCA) occlusion. (c) Four hours after tPA administration, the right MCA was recanalized.
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A magnetic resonance imaging (MRI) (diffusion-weighted image) showed right corona radiate infarction [Figure 1a]. MR angiography (MRA) revealed right middle cerebral artery (MCA) occlusion [Figure 1b]. Four hours later, consciousness gradually improved, the right MCA recanalized [Figure 1c], and volume of infarction was not changed.
(a-c) Thorax CT and chest X-ray performed 18 h after intravenous tPA in the 68-year-old man (Case 1) shows bilateral infiltrations in the middle and superior lobes suggesting diffuse alveolar hemorrhage (DAH). (d) Chest X-ray which performed 1 month after tPA shows full recovery of DAH.
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Chest computed tomography (CT) revealed multifocal diffuse ground-glass attenuation and patchy consolidation in both lungs [Figure 2a and b]. Immediate chest X-ray revealed bilateral upper lobe intra-alveolar infiltrate [Figure 2c]. After 1 month, the chest X-ray was normal [Figure 2d].
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(a) Bronchoalveolar lavage (BAL) was performed in the left upper lobe (Case 3). We observed progressive hemorrhagic BAL. BAL fluid analysis shows an increase in red blood cells. (b) Autopsy of the lung tissue (x20) (Case 3) showing inflammatory cell infiltrate of septae and extravasation of red blood cells into alveolar spaces.
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The returned lavage fluid was bloody from aliquot to aliquot [Figure 3a]. Lung tissue obtained during autopsy showed neutrophilic septal infiltrates and associated alveolar hemorrhage [Figure 3b].
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