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CASE REPORT
An unusual presentation of pulmonary embolism leading to infarction, cavitation, abscess formation and bronchopleural fistulation
  1. Eva Teng,
  2. Luke Bennett,
  3. Tommaso Morelli,
  4. Anindo Banerjee
  1. Department of Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  1. Correspondence to Dr Eva Teng, drevateng{at}gmail.com

Summary

We report an unusual presentation of pulmonary embolism (PE) where a 58-year-old man first developed symptoms of community-acquired pneumonia. Despite antibiotic therapy, he remained unwell with rising inflammatory markers, general malaise and persistent cough. He developed stony dull percussion and absent breath sounds to his left mid to lower zones. Serial chest x-rays showed progression from lobar consolidation to a large loculated left-sided pleural collection. CT chest showed left-sided lung abscess, empyema and bronchopleural fistulation. Incidentally, the scan revealed acute left-sided PE and its distribution corresponded with the location of the left lung abscess and empyema. The sequence of events likely started with PE leading to infarction, cavitation, abscess formation and bronchopleural fistulation. This patient was managed with a 6-month course of rivaroxaban. After completing 2 weeks of intravenous meropenem, he was converted to 4-week course of oral co-amoxiclav and metronidazole and attained full recovery.

  • pneumonia (respiratory medicine)
  • pulmonary embolism
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Footnotes

  • Contributors ET: contributed to collecting the relevant data/result (eg, blood test result and radiograph findings), as well as the writing of the case report; conducted literature review. LB: contributed to the planning of this case report, as well as the writing of the case report. TM: contributed to the writing of the case report and proofread the final draft. AB: contributed to the idea and planning of the case report, edited multiple drafts and proofread the final version; interpreted the radiological images.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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