Septic Emboli:
- Septic emboli are infected thromboembolic material originating from a distant infectious source, traveling via the bloodstream, and lodging in the pulmonary vasculature.
- They result in localized infection and inflammation, leading to pulmonary parenchymal damage.
![](https://beta.thecommonvein.net/wp-content/uploads/2024/12/b11422c-heart-lungs-bacterial-endocarditis-BE-mycotic-pseudoaneurysm-lung-abscess-feeding-vessel-sign-39F-002.jpg)
CT scan in a 39 year old female with endocarditis presents with a fever and right sided chest pain.
Multiple views in axial (a,c) coronal (b) and sagittal reveals the presence of a wedge shaped consolidation with cavitation confirming the presence of an infected and cavitating infarction in the posterior segment of the left upper lobe. A loculated effusion is noted at the left base.
Ashley Davidoff TheCommonVein.net
b11422c
![](https://beta.thecommonvein.net/wp-content/uploads/2024/12/b11422cL-heart-lungs-bacterial-endocarditis-BE-mycotic-pseudoaneurysm-lung-abscess-feeding-vessel-sign-39F-002.jpg)
CT scan in a 39 year old female with endocarditis presents with a fever and right sided chest pain.
Multiple view in axial (a,c) coronal (b) and sagittal confirm the presence of a wedge shaped consolidation with cavitation (red arrowhead a,b,c, and d) confirming the presence of an infected and cavitating infarction in the posterior segment of the left upper lobe. A second similar subsegmental infarct and abscess (yellow arrowhead, is noted in the right lower lobe (b yellow arrowhead) . A loculated effusion is noted at the left base.
Ashley Davidoff TheCommonVein.net b11422cL
![](https://beta.thecommonvein.net/wp-content/uploads/2024/03/b11302-lung-Septic-emboli-PV-endocarditis-empyema-mycotic-aneurysm-pulmonary-artery.jpg)
Bacterial Endocarditis (BE) and Mycotic Pseudoaneurysm Lung Abscess 39F
Ashley Davidoff TheCommonVein.net b11422b02
![](https://beta.thecommonvein.net/wp-content/uploads/2023/03/24f-PE-HAmptons-hump-003-septic-emboli.jpg)
Ashley Davidoff MD TheCommonvein.net 24f PE Hampton’s hump 003
![](https://beta.thecommonvein.net/wp-content/uploads/2023/03/24f-PE-HAmptons-hump-002-septic-emboli.jpg)
Ashley Davidoff MD TheCommonvein.net 24f PE Hampton’s hump 002
Causes
- Primary Infections:
- Infective endocarditis (most common).
- Infected venous catheters.
- Soft tissue infections (e.g., abscesses, IV drug use-related infections).
- Septic thrombophlebitis.
- Organisms: Staphylococcus aureus (including MRSA), Streptococcus spp., and gram-negative organisms.
Results
- Small peripheral pulmonary infarcts with subsequent infection and abscess formation.
- Multiple nodules, cavitation, or consolidations.
- Complications:
- Empyema.
- Pleural effusion.
- Bronchopleural fistulas.
Diagnosis
- Clinical Presentation:
- Fever, chills, and malaise.
- Dyspnea, chest pain, or hemoptysis.
- History of risk factors (e.g., IV drug use, endocarditis, infected devices).
- Imaging:
- Chest X-ray (CXR):
- Multiple, bilateral nodules often in the lung periphery.
- Possible cavitation and air-fluid levels.
- May show pleural effusions or wedge-shaped infarcts.
- Chest CT:
- Multiple nodules or masses, often with cavitation.
- Peripheral and subpleural distribution.
- Feeding vessel sign: visible pulmonary artery leading to the lesion.
- Associated findings: empyema, pleural thickening, infarcts.
- Chest X-ray (CXR):
- Laboratory Tests:
- Elevated inflammatory markers (e.g., CRP, ESR, WBC count).
- Positive blood cultures identifying the pathogen.
- Echocardiography for endocarditis (transthoracic or transesophageal).
Treatment
- Antibiotics:
- Broad-spectrum coverage initially, adjusted based on blood culture results.
- Prolonged duration (e.g., 4?6 weeks for endocarditis-related septic emboli).
- Source Control:
- Remove or treat the primary source of infection (e.g., infected devices, abscess drainage).
- Surgical Intervention:
- Rarely required unless complications such as empyema or persistent infection arise.
Pearls
- Peripheral nodules with cavitation in IV drug users should raise suspicion for septic emboli.
- Always investigate for an underlying source of infection, especially endocarditis or IV drug use.
- Feeding vessel sign on CT is a characteristic finding.
- Early diagnosis and source control are critical to prevent complications.