Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

OBJECTIVES: Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care. METHODS: The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed. RESULTS: Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess. CONCLUSIONS: Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

MSCT diagnosis of septic pulmonary embolism / 实用放射学杂志

Objective To analyze the MSCT manifestations of septic pulmonary embolism(SPE)to explore the diagnosis value of MSCT.Methods The MSCT findings of eight patients with SPE were analyzed retrospectively.Results ① Of all 177 lesions,84 lesions located in both upper lobes,25 lesions located in right middle lobe and 68 lesions located in both lower lobes.② There were 106 nodules and 44 wedge shaped opacities in all the 8 cases,of which the 88 nodules (83.0%)and all of the wedge shaped opacities located in sub-pleural zones of the lung and the 18 nodules (1 7.0%)located in the inner and middle lung fields.In 6 cases,the 26 nodules (24.5%)and the 1 6 wedge shaped lesions (38.1%)had “feeding vessels”.③ There were 27 patchy shadows in 6 patients,of which 12 patchy shadows (44.4%)had air bronchogram.④ There were 18 cavities in 6 patients,of which 14 cavities (13.2%)located in nodules and 4 cavities (9.1%) in the wedge shaped lesions.There were 8 cysts in 4 patients,of which 6 cysts located in nodules (5.7%)and 2 cysts in the wedge shaped lesions (4.5%).⑤ The nodules and the wedge shaped lesions were enhanced slightly.⑥ Pleural effusion and pericardial effusion were found in 4 and 3 patients,repectively.⑦ Of 6 patients the follow-up MSCT scan in a short period showed the disease progressions. Conclusion SPE has characteristic manifestations in MSCT,and MSCT can provide valuable information for the diagnosis of SPE.

Disseminated staphylococcal infection in an immunocompetent adult: A case report

@#<p style="text-align: justify;">Septic pulmonary embolism is an uncommon disorder in which septic thrombi are mobilized from an infectious nidus and transported in the vascular system of the lungs. We report a case of a 52-year-old immunocompetent female who suffered from septic pulmonary embolism associated with polymyositis, deep venous thrombosis and pericardial effusion. Oxacillin-sensitive staphylococcus aureus (MSSA) was isolated from her sputum. Clinical presentation improved after incision of the muscle abscess and vancomycin treatment.</p>

Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

OBJECTIVES: Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. METHOD: We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. RESULTS: The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. CONCLUSION: The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis. .

Liver abscess and septic complications associated with advanced gastric cancer / 영남의대학술지

Pyogenic liver abscess with metastatic septic complications is a rare and serious infectious disease if not treated properly. Pyogenic liver abscesses are caused by bacterial, fungal, or parasitic organisms. Escherichia coli used to be the predominant causative agent, but Klebsiella pneumoniae emerged as a major cause in the 1990s. Liver abscesses are caused by hepatic invasion via many routes, such as, the biliary tree, portal vein, hepatic artery, direct extension, or penetrating trauma. Furthermore, diabetes mellitus and malignant conditions are established important risk factors of K. pneumoniae liver abscesses and of septic metastasis, and several recent studies have asserted that K. pneumoniae liver abscess might be a presentation of occult or silent colon cancer. We report a case of K. pneumoniae liver abscess, metastatic septic pulmonary embolism, and endophthalmitis associated with diabetes and advanced gastric cancer.

Klebsiella pneumoniae Liver Abscess Complicated With Septic Pulmonary Embolism

Klebsiella pneumoniae has been reported to be the most common pathogen causing pyogenic liver abscess. K. pneumoniae liver abscess occurs fairly often in patients with diabetes mellitus, and is commonly associated with metastatic infections such as brain abscess, endophthalmitis, lung abscess, osteomyelitis, prostatitis, necrotizing fasciitis and infection in other sites. Although septic pulmonary embolism (SPE) is uncommon, it is a serious metastatic complication of K. pneumoniae liver abscess. Chest computed tomography (CT) scans are crucial in making the early diagnosis of SPE; however, it does not provide the basis for a definitive diagnosis. A 70-year-old man was referred to the Department of Pulmonology due to cough and an abnormal chest radiography. The chest CT scans revealed relatively well-demarcated, round multiple nodules with peripheral preponderance, cavitary mass in the right upper lobe of the lung and low-density hepatic cystic masses. Bronchoscopic examination and percutaneous needle aspiration of the lung were performed, but there was no evidence of malignancy. Finally, K. pneumoniae was grown from a bronchial washing specimen and blood culture. Intravenous carbapenem was administered over a 3-week period and follow-up CT scans showed improvement in both the lung and the liver. We report a case of K. pneumoniae liver abscess complicated with SPE requiring differential diagnosis of hematogenous metastatic malignancy on CT scans in an elderly patient.

Embolia pulmonar séptica de origen cutáneo / Septic pulmonary embolism of cutaneous origin

La embolia pulmonar séptica es una enfermedad grave y poco frecuente que se caracteriza por presentar infiltrados pulmonares bilaterales asociados a un foco infeccioso extrapulmonar. Se relaciona principalmente a endocarditis derecha, tromboflebitis pelviana, accesos vasculares y menos frecuentemente a infecciones profundas como osteomielitis, artritis séptica o piomiositis. El Staphylococcus aureus meticilino-resistente adquirido en la comunidad (SAMR-AC) es un patógeno emergente, con alta virulencia y de rápida propagación, que afecta a sujetos sin enfermedades previas relacionadas o factores de riesgo conocidos. Causa infecciones de piel y partes blandas y con menor frecuencia infecciones graves como fascitis necrotizante, artritis séptica, osteomielitis, piomiositis y neumonía necrotizante. Su epidemiología, patogenia y manifestaciones clínicas difieren de las causadas por el SAMR adquirido en el hospital. Presentamos el caso de un varón de 67 años con embolias pulmonares sépticas causadas por SAMR-AC con origen en una infección cutánea.

Septic pulmonary embolism is a serious and rare illness characterized by pulmonary infiltrates associated with an extrapulmonary infectious focus. It is mainly related to right-sided endocarditis, pelvic thrombophlebitis, vascular access and less frequently to deep infections such as osteomyelitis, septic arthritis and pyomyositis. The community-acquired methicillin-resistant Staphylococcus aureus (MRSA) is an emerging pathogen with high virulence and rapid spread involving subjects without previous related diseases or known risk factors. It causes infections of skin and soft tissue and less frequently other serious infections such as necrotizing fascitits, septic arthritis, osteomyelitis, pyomyositis and necrotizing pneumonia. Epidemiologically, pathogenesis and clinical manifestations differ from those caused by MRSA acquired in the hospital. We present the case of a 67 year-old male with septic pulmonary embolism caused by community acquired MRSA that started with a skin infection.

A Case of Atypical Skull Base Osteomyelitis with Septic Pulmonary Embolism

Skull base osteomyelitis (SBO) is difficult to diagnose when a patient presents with multiple cranial nerve palsies but no obvious infectious focus. There is no report about SBO with septic pulmonary embolism. A 51-yr-old man presented to our hospital with headache, hoarseness, dysphagia, frequent choking, fever, cough, and sputum production. He was diagnosed of having masked mastoiditis complicated by SBO with multiple cranial nerve palsies, sigmoid sinus thrombosis, and septic pulmonary embolism. We successfully treated him with antibiotics and anticoagulants alone, with no surgical intervention. His neurologic deficits were completely recovered. Decrease of pulmonary nodules and thrombus in the sinus was evident on the follow-up imaging one month later. In selected cases of intracranial complications of SBO and septic pulmonary embolism, secondary to mastoiditis with early response to antibiotic therapy, conservative treatment may be considered and surgical intervention may be withheld.

Septic Pulmonary Embolism Ascribed to Periapical Periodontitis / Oral Science International

Septic pulmonary embolism is a rare condition, the common sources of which are bacterial endocarditis and infected venous catheters. Septic pulmonary embolism ascribed to dental infection is extremely rare. The present report describes a case of septic pulmonary embolism attributed to periapical periodontitis in a 39-year-old patient, who was admitted with persistent toothache, fever, and chest pain. Chest CT showed a feeding vessel sign and a target sign. A panoramic radiograph of the left maxillary bone showed alveolar bone loss in a horizontal pattern typical of periodontitis and periapical periodontitis. The patient was treated with intravenous antibiotics and teeth extraction. To our knowledge, only 4 cases of septic pulmonary embolism ascribed to dental infection have been reported in the English literature. These patients repeatedly developed dental infections but did not receive appropriate dental treatment including extraction of the causative teeth, leading to the development of septic pulmonary embolism. This paper may contribute to the limited clinical knowledge base regarding septic pulmonary embolism ascribed to periapical periodontitis. Effective oral care and removal of the primary source of infection, including extraction of the causative teeth, are important to prevent septic pulmonary embolism.

A Case of Pulmonary Septic Emboli after Removal of BCGoma / 소아알레르기및호흡기학회지

Septic pulmonary emboli occur when thrombi contain organisms such as bacteria, fungi, or parasites. The septic emboli reach the lung from a variety of sources, including infected venous catheter or pacemaker wires, right-sided bacterial endocarditis, sepsis, septic thrombophlebitis, osteomyelitis, peritonsillar and subcutaneous abscess. Early clinical detection, along with prompt administration of broad-spectrum antibiotics, is an important factor in the prognosis of patients, but unfortunately initial clinical diagnosis is often difficult because of nonspecific findings in clinical, laboratory data. But recently, the characteristic chest computed tormography (CT) and chest radiographic findings of septic emboli have been helpful in non-invasive diagnostic method of early detection. Especially, chest CT is an important method for confirming the presence of septic pulmonary emboli. We experienced a case of septic pulmonary embolism in a 5-month-old infant with fever and intermittent cough after removal of BCGoma. The diagnosis was made on the basis of a chest x-ray and a chest CT. The CT revealed the presence of multiple subpleural nodules, cavitation of nodules and feeding vessel signs. Methicillin resistant staphylococcus aureus was cultured in the wound swab culture on left axillary area. After administration of broad spectrum antibiotics, clinical and radiologic improvements were achieved.

A Case of Septic Pulmonary Embolism in Neonate

Septic pulmonary embolization is an uncommon condition in which the clot or fibrin matrix, contaminated with micro-organisms, lodge in the pulmonary arterial tree, leading to infarction, suppuration and other complications. The septic emboli reach the lung from a variety of sources, including acute suppurative pelvic thrombophlebitis, infective endocarditis involving tricuspid and pulmonary valve, osteomyelitis, suppurative lesions of the neck, infected venous catheters or pacemaker wires and sepsis. Early clinical detection, along with prompt administration of broad- spectrum antibiotics, is an important factor in the prognosis of patients, but the initial clinical diagnosis is often difficult because of nonspecific findings in clinical and laboratory data. Recently, the characteristic appearance of septic emboli by chest computed tomography (CT) has been described, and chest CT is an important modality for confirming the presence of septic pulmonary emboli. We experienced a case of septic pulmonary embolism in a 14-day-old neonate with cough, fever dyspnea. Initial conventional chest radiogaphs revealed bilateral infilterate, but chest CT revealed the presence of multiple peripheral nodules, cavitation of nodules and a distinct vessel leading to a pulmonary nodule which is referred to as a feeding vessel sign, which diagnosis suggests. Coagulase negative staphylococcus was cultured in the blood stream and clinical and radiologic improvement was achieved after adminstration of antibiotics.