title: [A case of septic pulmonary embolism accompanied with tricuspid valve endocarditis and pyogenic spondylitis].
abstract: A 54-year-old man was admitted with complaints of high fever and lumbago. A chest radiograph on admission showed bilateral multiple patchy infiltrations. Chest CT showed multiple nodules of various sizes, some with necrotic centers and feeding vessels in the peripheral areas. Some nodules had wedge-shaped consolidations aboutting the pleura. Echocardiography showed vegetation about 12 x 7 mm in size attached to the tricuspid valve. MR imaging of the lumbar vertebrae showed increased signal intensity in the vertebral bodies in L1-4 in T2-weighted images and a further increase of signal intensity by gadolinium enhancement in T1-weighted images. These findings led to a diagnosis of septic pulmonary embolism accompanied with tricuspid valve endocarditis and pyogenic spondylitis irrespective of a negative blood culture. The fever was reduced and the inflammatory findings and chest radiographs were improved by antibiotic therapy, and then tricuspid valvuloplasty was performed. The characteristic CT features of septic pulmonary embolism, mentioned above, can contribute to an accurate and early diagnosis and proper treatment.
authors.affiliation: Department of Internal Medicine and Molecular Therapeutics, Course of Bioregulation and Medical Oncology, University of Tokushima School of Medicine, 3-18-15, Kuramoto-cho, Tokushima, 770-8503, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Hanibuchi
authors.forename: Reika
authors.initials: R
authors.lastname: Shimada
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nishioka
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Shinohara
authors.forename: Saburo
authors.initials: S
authors.lastname: Sone
mesh_terms: D004697:Endocarditis, Bacterial / Q000150:complications*; D006349:Heart Valve Diseases / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications*; D018805:Sepsis / Q000150:complications*; D013166:Spondylitis / Q000150:complications*; D014261:Tricuspid Valve