Septic pulmonary emboli

Case contributed by Simon Ahmadpour
Diagnosis certain


6 hour history of bilateral pleuritic chest pain, fevers, productive cough and vomiting. Was seen in ED 24 hours prior complaining of foreign body in heel.

Patient Data

Age: 35 years
Gender: Male

CXR on admission


There is a nodular opacity to the peripheral aspect of the left mid zone. 

CTPA on admission


Multiple cavitating lesions are seen in the peripheries of both lung with bibasal collapse/consolidation. No pulmonary embolism is identified to the subsegmental level.

CT chest on day 6 of admission


Multifocal nodular lesions are seen involving bilateral lung parenchyma, the majority of which demonstrate central cavitation and air-fluid levels. Significant consolidation and atelectasis is seen in the dependent regions of both lungs. Large volume pleural effusions noted bilaterally. Right sided ICC in situ, extending along the horizontal fissure. ETT, NGT and right sided CVC noted.

Case Discussion

The patient was intubated in the ICU. Admission complicated by bilateral empyema formation requiring transfer to a tertiary center for VATS. MRSA was cultured in blood and sputum.

Septic emboli deposition in the pulmonary parenchyma are usually seen as multiple peripheral and subpleural nodular or wedge-shaped densities with variable degrees of central cavitation. Development of large pleural effusions in this context may signify the development of thoracic empyema.

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