Presentation
Fever, chest pain and hemoptysis. The patient was found to be a heroin addict.
Patient Data
Scout view shows a large left pleural effusion and multiple nodular peripheral opacities throughout the right lung.
Multiple small peripheral cavitating pulmonary nodules that display typical feeding vessel sign and left pleural effusion both free and loculated form. Small mediastinal lymph node is also noted.
Case Discussion
IV heroin injection leads to infected DVT of the lower limb which may fragment and migrate to the right atrium, then the right ventricle, and then the lungs resulting in septic pulmonary emboli and microabscesses.
The differential includes other cavitary lung nodules e.g. granulomatosis with polyangiitis, multiple hydatic cysts, necrobiotic nodules and cavitating metastatic deposits.
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