What's the Diagnosis? By Dr. Michael Tom

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 







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.