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Septic Pulmonary Emboli

Wallace JDW - MedPix (2010)

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Septic Pulmonary Emboli

History: 49-year-old male with PMH significant for end stage renal disease s/p external arteriovenous shunt placement for home dialysis presents with complaint of 3 days of fevers, chills, nausea, vomiting, anorexia, cough and pleuritic chest pain. Patient had similar signs and symptoms 1 year, was found to have MSSA bacteremia with septic pulmonary emboli. Following shunt replacement and antimicrobial therapy he demonstrated improvement. Denies tobacco, alcohol or illicit drug use. No family history of pulmonary disease or cancer

Findings: Rads: AP CXR demonstrates patchy alveolar infiltrates in bilateral lower lung zones. Representing loculated pleural effusions Chest CT demonstrates bilateral effusions with R>L. Multiple bilateral peripherally distributed nodular opacities with cavitations and feeding vessels leading to the peripheral lung lesions

Ddx: C- Carcinoma - Squamous is most common A- Autoimmune - Wegener's granulomatosis, Rheumatoid nodules V- Vascular - Emboli (septic emboli or bland emboli) I- Infection - Lung abscess, Bacterial pneumonia, Fungal pneumonia, Tuberculosis, Pneumatocele T- Trauma - Pulmonary laceration Y- Young (congenital) - Congenital cystic adenomatoid malformation, Pulmonary sequestration, Bronchogenic cyst

Dxhow: Based on patients clinical presentation, persistent MSSA bacteremia, typical radiographic findings of septic pulmonary emboli and history of diagnosis.

Exam: PE: Vital signs 101.9 130/90 98 22 97RA General Ill appearing morbidly obese male sitting on side of bed in mild respiratory distress Cardiovascular Mild tachycardia. No murmurs rubs or gallops Pulmonary Mild tachypnea with decreased breath sounds at base R>L Abdominal Soft, nontender, nondistended with normal active bowel sounds Labs: WBC 15.8, H/H 9.7/29.1, Plt 256 G 91% ESR 105, CRP 19.407 BUN/Cr 71/12.2 Blood Cx MSSA

No MeSH data available.


demonstrates bilateral effusions with R>L.  Multiple bilateral peripherally distributed nodular opacities with cavitations and feeding vessels leading to the peripheral lung lesions.
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MPX1509_synpic52773: demonstrates bilateral effusions with R>L. Multiple bilateral peripherally distributed nodular opacities with cavitations and feeding vessels leading to the peripheral lung lesions.


Septic Pulmonary Emboli

Wallace JDW - MedPix (2010)

demonstrates bilateral effusions with R>L.  Multiple bilateral peripherally distributed nodular opacities with cavitations and feeding vessels leading to the peripheral lung lesions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=MPX1509&req=5

MPX1509_synpic52773: demonstrates bilateral effusions with R>L. Multiple bilateral peripherally distributed nodular opacities with cavitations and feeding vessels leading to the peripheral lung lesions.

View Article: MedPix Image - MedPix Case

Affiliation: Uniformed Services University

ABSTRACT

Diagnosis: Septic Pulmonary Emboli

History: 49-year-old male with PMH significant for end stage renal disease s/p external arteriovenous shunt placement for home dialysis presents with complaint of 3 days of fevers, chills, nausea, vomiting, anorexia, cough and pleuritic chest pain. Patient had similar signs and symptoms 1 year, was found to have MSSA bacteremia with septic pulmonary emboli. Following shunt replacement and antimicrobial therapy he demonstrated improvement. Denies tobacco, alcohol or illicit drug use. No family history of pulmonary disease or cancer

Findings: Rads: AP CXR demonstrates patchy alveolar infiltrates in bilateral lower lung zones. Representing loculated pleural effusions Chest CT demonstrates bilateral effusions with R>L. Multiple bilateral peripherally distributed nodular opacities with cavitations and feeding vessels leading to the peripheral lung lesions

Ddx: C- Carcinoma - Squamous is most common A- Autoimmune - Wegener's granulomatosis, Rheumatoid nodules V- Vascular - Emboli (septic emboli or bland emboli) I- Infection - Lung abscess, Bacterial pneumonia, Fungal pneumonia, Tuberculosis, Pneumatocele T- Trauma - Pulmonary laceration Y- Young (congenital) - Congenital cystic adenomatoid malformation, Pulmonary sequestration, Bronchogenic cyst

Dxhow: Based on patients clinical presentation, persistent MSSA bacteremia, typical radiographic findings of septic pulmonary emboli and history of diagnosis.

Exam: PE: Vital signs 101.9 130/90 98 22 97RA General Ill appearing morbidly obese male sitting on side of bed in mild respiratory distress Cardiovascular Mild tachycardia. No murmurs rubs or gallops Pulmonary Mild tachypnea with decreased breath sounds at base R>L Abdominal Soft, nontender, nondistended with normal active bowel sounds Labs: WBC 15.8, H/H 9.7/29.1, Plt 256 G 91% ESR 105, CRP 19.407 BUN/Cr 71/12.2 Blood Cx MSSA

No MeSH data available.