Pulmonary cavitation in a patient presenting with nonspecific complaints

• Published in: The American journal of emergency medicine 2012-10, Vol.30 (8), p.1662.e1-1662.e3
• Main Authors: Messmer, Anna Sarah, MD, Kubera, Katharina M., MD, Buser, Paul J., MD, Tamm, Michael, MD, Muenst, Simone, MD, Nickel, Christian H., MD, Bingisser, Roland, MD
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Antibiotics; Anticoagulants; Cardiovascular disease; Cavitation; Chronic obstructive pulmonary disease; Complaints; Diagnosis, Differential; Emergency; Emergency medical care; Female; Humans; Lung - diagnostic imaging; Lung - pathology; Medical treatment; Pain; Pulmonary Embolism - diagnosis; Pulmonary Embolism - diagnostic imaging; Pulmonary Embolism - pathology; Pulmonary Infarction - diagnosis; Pulmonary Infarction - diagnostic imaging; Pulmonary Infarction - pathology; Tomography, X-Ray Computed
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2011.09.004

Most commonly, patients with pulmonary embolism present with dyspnea, chest pain, and/or tachypnea to the emergency department (ED). The presence of multiple suggestive symptoms, especially when severe, significantly reduces delay in diagnosis. We report a case of an 86-year-old patient presenting to the ED with nonspecific complaints: she claimed to feel lethargic and “reluctant to prepare meals.” She did not complain of either dyspnea or chest pain. As underlying cause, an intrapulmonary cavitation with pulmonary embolism was found. The combination of absence of specific symptoms regarding pulmonary embolism and radiologic findings of an obstructed pulmonary artery supplying the cavitary lung segment is rare. Common etiologies of cavitary lung processes are discussed, and risk factors of pulmonary infarction are highlighted.