Septic pulmonary embolism: presenting features and clinical course of 14 patients.
BACKGROUND
Septic pulmonary embolism (SPE) is an uncommon disorder with an insidious onset and is difficult to diagnose.


OBJECTIVE
To characterize the presenting features and clinical course of patients with SPE.


METHODS
Retrospective study.


METHODS
Tertiary care, referral medical center.


METHODS
Fourteen subjects with SPE diagnosed during a 6-year period between 1996 and 2002.


METHODS
None.


RESULTS
The median age of these patients was 37.5 years (range, 14 to 81 years) and included five women. Presenting symptoms included fever (93%), dyspnea (36%), pleuritic chest pain (29%), cough (14%), and hemoptysis (7%). The median duration of symptoms before diagnosis was 18 days (range, 5 to 180 days). A potential source or underlying condition that predisposed to SPE was identified in all 14 patients and included Lemierre syndrome (4 patients), central venous catheter infection (3 patients), prosthetic cardiac valve (2 patients), and pacemaker infection (2 patients). Two patients had a focal extrapulmonary infection, and one patient was an IV drug user. Most common pathogens were staphylococcal species (eight patients) and fusobacterium (four patients). Chest radiographic presentation was usually nonspecific, but CT was more helpful and revealed multiple nodular opacities peripherally, often with cavitation. Transesophageal echocardiography was performed in eight patients and demonstrated infectious vegetations in four cases. Aside from antimicrobial therapy and removal of infected devices, the management of these patients included cardiac surgery (two patients), thoracoscopic surgery with decortication (one patient), and tube thoracostomy (one patient). All 14 patients recovered from their illness.


CONCLUSIONS
We conclude that SPE presents with variable and often nonspecific clinical and radiographic features. The diagnosis is usually suggested by the presence of a predisposing factor, febrile illness, and CT findings of multiple, nodular lung infiltrates peripherally, with or without cavitation.
Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Rachel J
RJ
Cook
Rendell W
RW
Ashton
Gregory L
GL
Aughenbaugh
Jay H
JH
Ryu
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000175:diagnosis* / Q000382:microbiology*; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology*; D014057:Tomography, X-Ray Computed