Department of Medicine - Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
Thromb Res. 2021 Jun;202:162-169. doi: 10.1016/j.thromres.2021.03.022. Epub 2021 Apr 1.
Pulmonary infarction results from occlusion of the distal pulmonary arteries leading to ischemia, hemorrhage and ultimately necrosis of the lung parenchyma. It is most commonly caused by acute pulmonary embolism (PE), with a reported incidence of around 30%. Following an occlusion of the pulmonary artery, the bronchial arteries are recruited as primary source of perfusion of the pulmonary capillaries. The relatively higher blood pressure in the bronchial circulation causes an increase in the capillary blood flow, leading to extravasation of erythrocytes (i.e. alveolar hemorrhage). If this hemorrhage cannot be resorbed, it results in tissue necrosis and infarction. Different definitions of pulmonary infarction are used in literature (clinical, radiological and histological), although the diagnosis is nowadays mostly based on radiological characteristics. Notably, the infarcted area is only replaced by a fibrotic scar over a period of months. Hence and formally, the diagnosis of pulmonary infarction cannot be confirmed upon diagnosis of acute PE. Little is known of the impact and relevance of pulmonary infarction in acute PE, and whether specific management strategies should be applied to prevent and/or treat complications such as pain, pneumonia or post-PE syndrome. In this review we will summarize current knowledge on the pathophysiology, epidemiology, diagnosis and prognosis of pulmonary infarction in the setting of acute PE. We highlight the need for dedicated studies to overcome the current knowledge gaps.
肺梗死是由远端肺动脉阻塞导致的缺血、出血，最终导致肺实质坏死。它最常见于急性肺栓塞（PE），据报道其发病率约为 30%。在肺动脉阻塞后，支气管动脉被招募为肺毛细血管的主要灌注源。支气管循环中的相对较高血压导致毛细血管血流增加，导致红细胞外渗（即肺泡出血）。如果这种出血不能被吸收，就会导致组织坏死和梗死。肺梗死在文献中有不同的定义（临床、放射学和组织学），尽管现在的诊断主要基于放射学特征。值得注意的是，梗死区域仅在数月内被纤维疤痕取代。因此，在诊断急性 PE 时，不能明确诊断为肺梗死。人们对急性 PE 中肺梗死的影响和相关性知之甚少，也不知道是否应该应用特定的管理策略来预防和/或治疗疼痛、肺炎或 PE 后综合征等并发症。在这篇综述中，我们将总结急性 PE 中肺梗死的病理生理学、流行病学、诊断和预后的现有知识。我们强调需要进行专门的研究来克服当前的知识空白。
