Pulmonary thromboembolism presenting as a cavitating lesion on chest X-ray

Abstract

Pulmonary embolism presenting as a cavitating lesion on a chest X-ray is described in a patient with a six-week history of worsening dyspnoea. A chest X-ray performed 27 days earlier did not show the cavitating lesion. On the day of presentation, the patient had developed streak haemoptysis. Due to the progressive nature of dyspnoea, hypoxia and the rapid development of the cavitating lesion on the X-ray, pulmonary infarction leading to cavitation secondary to pulmonary thromboembolism was considered to be among the list of differential diagnoses. The modified Wells criteria for this patient were 2·5 (Heart rate > 100, haemoptysis). This diagnosis was confirmed on CTPA, which showed the presence of large pulmonary emboli in the pulmonary vasculature supplying the affected lobe. Subsequent Doppler ultrasound revealed the presence of a below right knee thrombosis. Although rare, cavitation has previously been observed in patients with pulmonary thromboembolism.1–3