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Septic Emboli to the Lungs 

 

  • Age
    • Majority <40 years
  • Predisposed
    • IV drug abusers
    • Alcoholism
    • Immunodeficiency
    • CHD
    • Dermal infection (cellulitis, carbuncles)
  • Sources
    • Tricuspid valve endocarditis
      • Most common cause in IV drug abusers
    • Pelvic thrombophlebitis
    • Infected venous catheter or pacemaker wire
    • Arteriovenous shunts for hemodialysis
    • Drug abuse producing septic thrombophlebitis (eg, heroin addicts)
    • Peritonsillar abscess
    • Osteomyelitis
  • Organism
    • S. aureus
    • Streptococcus
  • Clinical Findings
    • Sepsis
    • Cough
    • Dyspnea
    • Hemoptysis
      • Sometimes massive
    • Chest pain
    • Shaking chills
    • High fever
    • Severe sinus tachycardia
  • Location
    • Predilection for lung bases
  • Imaging Findings
    • Multiple round or wedge-shaped densities
    • Cavitation
      • Frequent
      • Usually thin-walled
    • Migratory
      • Old ones clear and new ones arise
    • Pleural effusion is rare
    • Hilar and mediastinal adenopathy can occur

Two images from an axial contrast-enhanced CT scan of the chest shows multiple
peripheral, thin-walled cavitary lesions consistent with septic emboli

  • CT findings
    • Multiple peripheral parenchymal nodules
    • Cavitation or air bronchogram in more than 89%
      • Cavities are thin-walled and may have no fluid level
    • Wedge-shaped subpleural lesion with apex of lesion directed toward pulmonary hilum (50%)
    • Feeding vessel sign = pulmonary artery leading to nodule (67%)

 

Differential Diagnosis of Small Cavitary Lung Lesions

Septic emboli 

Rheumatoid nodules

Squamous or transitional cell mets

Wegener’s Granulomatosis

 

  • Complications

    • Empyema (39%)

 

Dahnert 5th ed

Fraser and Pare

Thoracic Radiology Requisites