Pulmonary septic emboli

Case contributed by Dr Karim Hussein

Presentation

Admitted with cellulitis in right arm secondary to IV drug use. During admission, developed pleuritic chest pain. CTPA ordered to exclude pulmonary embolus.

Patient Data

Age: 35 years old
Gender: Male
Modality: X-ray

Initial x-ray performed on onset of pleuritic chest pain.

Rounded opacities present in relation to the lungs bilaterally with the largest discrete areas at the left lung base and the right mid zone.

Modality: CT

Multiple peripheral pleural based nodular densities are seen.

These densities are associated with feeding vessels.

Some of the larger densities show suggestion of internal necrosis.

Findings consistent with septic emboli with cavitatory infarcts.

Case Discussion

The differentials for cavitating lung lesions on CT are diverse and include metastases, necrobiotic lung lesions and rheumatoid disease.

However given this clinical scenario of a young patient with a history of recent IV drug use and current cellulitis/infection of his right arm the diagnosis of pulmonary septic emboli is by far the most likely. 

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Case Information

rID: 50308
Case created: 30th Dec 2016
Last edited: 30th Dec 2016
System: Chest
Inclusion in quiz mode: Included

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