An Unusual Initial Manifestation of Pulmonary Embolism: Aseptic Cavitary Infarction With Pulmonary Hypertension—Case Report and Literature Review

Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare but serious consequence of acute pulmonary embolism occurring in about 0.4%-6.2% of cases. Pulmonary infarction is an infrequent complication due to the lung's dual blood supply. Cavitary pulmonary infarction without infection is an exceedingly rare manifestation in CTEPH. We are reporting a 44-year-old woman who presented with lower limb swelling, cough, haemoptysis, and dyspnoea. Evaluation confirmed CTEPH with an aseptic cavitary infarct in the context of a heterozygous Factor V Leiden (1691G > A) mutation. She responded well to anticoagulation and riociguat, showing marked clinical improvement and complete resolution of the cavity on follow-up imaging. Family screening showed that both children carried the same mutation, highlighting the value of genetic testing in patients with unexplained CTEPH.