Monday, July 22, 2013

Septic Pulmonary Emboli

Septic emboli, pulmonary CT
Often seen in IV drug users or immunocompromised patients with right sided bacterial endocarditis. Unhygienic IV drug use may inadvertently inject skin flora into the bloodstream which then seeds the tricuspid valve, shooting off emboli into the lungs. Physical exam may reveal a holosystolic murmur that increases in intensity with inspiration. Note the bilateral peripheral parenchymal nodules on lung CT.
Septic pulmonary emboli is embolization of intravascular thrombus containing microorganisms into the lungs. Septic emboli can occur from varying sources like tricuspid valve endocarditis, infection elsewhere in the body with associated septal defect, infected deep venous thrombosis, venous lines / central venous catheters, pacemaker wires etc.

On CT chest, "vessel sign" is interesting to watch with peripheral nodules with clearly identifiable feeding vessels. May be visible are - subpleural nodular lesions or wedge-shaped densities with or without necrosis caused by septic infarcts.

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