Pulmonary infarction (PI) results from severe perfusion disturbance in the context of pulmonary artery embolism (PE). However, it is not necessarily correlated with the severity of the PE concerning thrombus burden and site of occlusion [1, 2]. The dual vascular supply of the lungs, consisting of the pulmonary and bronchial circulation, plays a crucial role in maintaining tissue perfusion despite vascular obstruction [3, 4]. The bronchial circulation exhibits approximately six-fold higher systemic pressure compared to the pulmonary circulation, enabling it to partially compensate for occlusions by supplying blood to the affected tissue [3-5]. Nonetheless, this compensation is limited, particularly in cases of distal emboli [1], where bronchial pressure may exceed the capacity of the local capillary network, resulting in intra-alveolar hemorrhage. If this hemorrhage is not adequately resorbed, it can progress to a true infarction with tissue necrosis [1, 6].

Spectral detector computed tomography (SDCT) facilitates the detection of peripheral PE and the quantitative assessment of pulmonary perfusion, offering novel opportunities for the characterization of perfusion disturbances [7-10]. The objective of this retrospective study is to utilize SDCT to investigate pulmonary perfusion and the location of occlusions in patients with acute PE. By analyzing iodine density maps, we seek to gain deeper insights into the pathophysiology of PI.