What's the Diagnosis? By Dr. Michael Tom
Wed, 01/10/2018 - 6:08am
A 31 yo male with a history of hepatitis C, IV drug use, and homelessness presents with an influenza-like illness. He complains of 2 days of fever, cough, malaise and sharp chest pain. Chest x-ray shows bilateral nonspecific opacifications. A chest cat scan is shown below. What's the diagnosis? (scroll down for answer)
Answer: Septic Pulmonary Emboli
- Varying sized nodular or cavitary lesions are seen on cat scan and less commonly on plain x-ray
- Patients may have minimal symptom burden, so high index of suspicion is warranted in the immunocompromised, IV drug users, and patients with indwelling devices (PICC lines, grafts, pacemakers)
- Common embolic sources: tricuspid valve vegetations, infected DVT, periodontal disease
- Work-up includes echocardiogram and blood cultures
- Treat with antibiotics, source control, and occasionally surgical drainage
- Emboli can travel elsewhere - pursue neurologic, abdominal and extremity evaluations when clincally indicated
References:
https://radiopaedia.org/articles/septic-pulmonary-emboli
https://www.uptodate.com/contents/complications-and-outcome-of-infective...
Li Zhao RY, Wang C, Wu X, Yan H. Clinical characteristics of septic pulmonary embolism in adults: A systematic review. Respiratory Medicine. 2013; 108(1):1-8.