The preferred treatment of pulmonary infarction is nonoperative when the diagnosis can be established. In the present study, five cases are described in which failure of resolution or growth of a radiographic density resulted in eventual thoracotomy and pulmonary resection. Carcinoma was suspected in each case, and in one patient, unremitting hemoptysis was an additional indication for operation. It is thought that the infarction was due to an embolus in four patients and to pulmonary arterial thrombosis in the other. Only one of the patients had evidence of peripheral thrombophlebitis, and none had underlying cardiac disease. The infarcts involved the upper lobes in two patients, the lower lobes in two, and both the upper and lower lobes in one. The benign nature of the process was recognized at operation and conservative resections performed. The typical finding was atelectasis of the involved parenchyma with a central necrotic area. In two patients organizing pulmonary emboli were encountered when transecting the pulmonary arterial supply, and in one of these, pulmonary endarterectomy of the remaining vessel was successfully performed. The apparent ages of the infarcts ranged from two weeks to several months. After the diagnosis had been established at operation, prophylactic anticoagulant therapy was not given in four patients, and no recurrences were observed. In the fifth, bilateral superficial femoral vein ligation was performed, also with a good result. © 1963
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