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76year old female presents with dyspnea  sepsis and bacteremia

CXR
Thick Walled Cystic lesions

76year old female presents with dyspnea  sepsis and bacteremia,  Frontal CXR reveals thick walled cystic changes clustered in the right apex and similar single thick walled cystic spaces in the right costophrenic angle and alongside the left heart border.  There is silhouetting of the left hemidiaphragm.  Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33005
76year old female presents with dyspnea  sepsis and bacteremia, 
Frontal CXR reveals thick walled cystic changes clustered in the right apex (red ring a and c)   and similar single thick walled cystic spaces in the right costophrenic angle yellow ring, magnified in a and b) and alongside the left heart border (green ring in a and d).  There is silhouetting of the left hemidiaphragm.  Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33005cL

CT
Thick Walled Cystic Lesions
Bacteremia – Septic Emboli

76year old female presents with dyspnea  sepsis and bacteremia, 
Axial CT  reveals multiple small thick walled cystic changes clustered in the apices bilaterally, and thickening of the interlobular septa There is a large right pleural effusion.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33011
76year old female presents with dyspnea  sepsis and bacteremia, 
Axial CT  reveals a thick walled complex cystic nodule alongside a solid nodule clustered in the right apex, and thickening of the interlobular septa There is a large right pleural effusion.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33010

Wedge Shaped Cystic Complex with
Feeding Bronchovascular Bundle
Cavitating Hampton’s Hump

76year old female presents with dyspnea  sepsis and bacteremia, 
Axial CT  reveals a large wedge shaped thick walled complex multicystic lesion associated with a feeding bronchovascular bundle (feeding vessel sign) in the right apex consistent with a cavitating infarction (cavitating Hampton’s hump).  In addition there is a second smaller unilocular thick-walled cyst with a small air fluid level suggesting infection.  There are pleural effusions.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33012
76year old female presents with dyspnea  sepsis and bacteremia, 
Axial CT  reveals a large wedge shaped thick walled complex multicystic lesion associated with a feeding bronchovascular bundle (feeding vessel sign) in the right apex consistent with a cavitating infarction (cavitating Hampton’s hump).  In addition there is a second smaller unilocular thick-walled cyst with a small air fluid level suggesting infection.  There are pleural effusions.   Echo showed tricuspid valve vegetations. Diagnosis is consistent with cavitating septic emboli with pulmonary infarction.
Ashley Davidoff TheCommonVein.net 33012
76year old female presents with dyspnea  sepsis and bacteremia, 
Axial CT  reveals a large wedge shaped thick walled complex multicystic lesion ( bordered by orange lines in b) associated with a feeding bronchovascular bundle (red ring b -feeding vessel sign) in the right apex consistent with a cavitating infarction (cavitating Hampton’s hump).  In addition there is a second smaller unilocular thick-walled cyst with a small air fluid level (yellow arrow, a) suggesting additional purulence in this clinical context.  There are bilateral pleural effusions.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli with pulmonary infarction.
Ashley Davidoff TheCommonVein.net 33012

 

Additional Cavitating Nodules and a
Small Nodule with a Halo

76year old female presents with dyspnea  sepsis and bacteremia, 
Axial CT  reveals a thick walled complex cystic nodule alongside in the lingula with a small air fluid level and a smaller right upper lobe nodule with a ground glass halo. There are large bilateral pleural effusions associated with compressive atelectasis.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33014
76year old female presents with dyspnea  sepsis and bacteremia
Axial CT  reveals a thick walled wedge shaped bilocular cystic  lesion in a region of subsegmental consolidation associated with a feeding bronchovascular bundle (feeding vessel sign).  There are large bilateral pleural effusions associated with compressive atelectasis.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33015
76year old female presents with dyspnea  sepsis and bacteremia
Axial CT  reveals a thick walled wedge shaped bilocular cystic  lesion in a region of subsegmental consolidation associated with a feeding bronchovascular bundle (feeding vessel sign) magnified in image b.  There are large bilateral pleural effusions associated with compressive atelectasis.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33015c
76year old female presents with dyspnea  sepsis and bacteremia
Axial CT  reveals a thick walled wedge shaped (orange triangle in b) bilocular cystic  lesion in a region of subsegmental consolidation associated with a feeding bronchovascular bundle (red ring b – feeding vessel sign).  There are large bilateral pleural effusions associated with compressive atelectasis.   Echo showed tricuspid valve vegetations.  Diagnosis is consistent with cavitating septic emboli
Ashley Davidoff TheCommonVein.net 33015cL