## PE with Pulmonary Infarction: Hampton's Hump ### Definition and Pathophysiology **Key Point:** Hampton's hump is a wedge-shaped peripheral consolidation that represents pulmonary infarction — tissue necrosis due to PE in a patient with compromised bronchial circulation (e.g., heart failure, pre-existing lung disease). ### Imaging Characteristics of Hampton's Hump | Feature | Details | |---------|----------| | **Shape** | Wedge or cone | | **Apex** | Points toward the hilum | | **Base** | Lies at the pleural surface | | **Location** | Usually peripheral, lower lobes | | **Timeline** | Appears 24–72 hours after PE | | **Associated findings** | Pleural effusion (often hemorrhagic), pleural thickening | | **Frequency** | Only 5–10% of PE cases (requires dual circulation compromise) | **High-Yield:** Hampton's hump is PATHOGNOMONIC for PE with infarction, but it is uncommon because most patients have intact bronchial circulation that prevents necrosis. ### Why Infarction is Rare in PE **Clinical Pearl:** The lungs have dual blood supply (pulmonary + bronchial arteries). PE alone rarely causes infarction unless: - Pre-existing cardiopulmonary disease (heart failure, COPD, prior PE) - Compromised bronchial circulation - Massive PE with complete obstruction ### Distinguishing Infarction from Simple PE Uncomplicated PE may show: - Thrombus in pulmonary arteries - RV dilatation (acute cor pulmonale) - Mosaic perfusion - **But NO parenchymal consolidation** PE with infarction additionally shows: - **Hampton's hump** (wedge consolidation) - Pleural effusion - Pleural thickening **Mnemonic:** **HUMP** = **H**emorrhagic infarction, **U**ncommon (5–10%), **M**ultiple risk factors, **P**eripheral wedge. [cite:Robbins 10e Ch 15] 
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