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Cardiac septic pulmonary embolism

View Article: PubMed Central - PubMed

ABSTRACT

Based on the source of the embolus, septic pulmonary embolism (SPE) can be classified as cardiac, peripheral endogenous, or exogenous. Cardiac SPEs are the most common.

We conducted a retrospective analysis of 20 patients with cardiac SPE hospitalized between 1991 and 2013 at a Chinese tertiary referral hospital.

The study included 14 males and 6 females with a median age of 38.1 years. Fever (100%), cough (95%), hemoptysis (80%), pleuritic chest pain (80%), heart murmur (80%), and moist rales (75%) were common clinical manifestations. Most patients had a predisposing condition: congenital heart disease (8 patients) and an immunocompromised state (5 patients) were the most common. Staphylococcal (8 patients) and Streptococcal species (4 patients) were the most common causative pathogens. Parenchymal opacities, nodules, cavitations, and pleural effusions were the most common manifestations observed via computed tomography (CT). All patients exhibited significant abnormalities by echocardiography, including 15 patients with right-sided vegetations and 4 with double-sided vegetations. All patients received parenteral antimicrobial therapy as an initial treatment. Fourteen patients received cardiac surgery, and all survived.

Among the 6 patients who did not undergo surgery, only 1 survived. Most patients in our cardiac SPE cohort had predisposing conditions. Although most exhibited typical clinical manifestations and radiography, they were nonspecific. For suspected cases of SPE, blood culture, echocardiography, and CT pulmonary angiography (CTPA) are important measures to confirm an early diagnosis. Vigorous early therapy, including appropriate antibiotic treatment and timely cardiac surgery to eradicate the infective source, is critical.

No MeSH data available.


Related in: MedlinePlus

A 44-year-old non-drug user and healthy man suffered from SPE after his right big toe was accidentally injured by a falling iron bar. The chest CT showed multiple nodules, cavities, and patches in both lungs (A). His CTPA showed multiple pulmonary embolisms (B). The repeated chest CT, which was performed after cardiac surgery (tricuspid vegetation removal and valvuloplasty), and antibiotics showed his lung shadows had disappeared (C). CT = computed tomography, CTPA = CT pulmonary angiography, SPE = septic pulmonary embolism.
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Figure 1: A 44-year-old non-drug user and healthy man suffered from SPE after his right big toe was accidentally injured by a falling iron bar. The chest CT showed multiple nodules, cavities, and patches in both lungs (A). His CTPA showed multiple pulmonary embolisms (B). The repeated chest CT, which was performed after cardiac surgery (tricuspid vegetation removal and valvuloplasty), and antibiotics showed his lung shadows had disappeared (C). CT = computed tomography, CTPA = CT pulmonary angiography, SPE = septic pulmonary embolism.

Mentions: All patients underwent chest CTs, and all scans were abnormal (HRCT; Figs. 1 and 2) (informed written consent was obtained for the publication of individual personal information from these 2 patients). Ten patients were diagnosed as PE by CTPA plus computed tomographic venography (CTV). Seven cases were diagnosed as having a PE by V/Q scan. Three patients, all of whom suffered sudden death, were diagnosed with a PE by multidisciplinary discussion between experienced PE experts in respiratory, cardiological, hematological, and radiological departments based on the combination of clinical manifestations in the context of cardiovascular vegetations.


Cardiac septic pulmonary embolism
A 44-year-old non-drug user and healthy man suffered from SPE after his right big toe was accidentally injured by a falling iron bar. The chest CT showed multiple nodules, cavities, and patches in both lungs (A). His CTPA showed multiple pulmonary embolisms (B). The repeated chest CT, which was performed after cardiac surgery (tricuspid vegetation removal and valvuloplasty), and antibiotics showed his lung shadows had disappeared (C). CT = computed tomography, CTPA = CT pulmonary angiography, SPE = septic pulmonary embolism.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998308&req=5

Figure 1: A 44-year-old non-drug user and healthy man suffered from SPE after his right big toe was accidentally injured by a falling iron bar. The chest CT showed multiple nodules, cavities, and patches in both lungs (A). His CTPA showed multiple pulmonary embolisms (B). The repeated chest CT, which was performed after cardiac surgery (tricuspid vegetation removal and valvuloplasty), and antibiotics showed his lung shadows had disappeared (C). CT = computed tomography, CTPA = CT pulmonary angiography, SPE = septic pulmonary embolism.
Mentions: All patients underwent chest CTs, and all scans were abnormal (HRCT; Figs. 1 and 2) (informed written consent was obtained for the publication of individual personal information from these 2 patients). Ten patients were diagnosed as PE by CTPA plus computed tomographic venography (CTV). Seven cases were diagnosed as having a PE by V/Q scan. Three patients, all of whom suffered sudden death, were diagnosed with a PE by multidisciplinary discussion between experienced PE experts in respiratory, cardiological, hematological, and radiological departments based on the combination of clinical manifestations in the context of cardiovascular vegetations.

View Article: PubMed Central - PubMed

ABSTRACT

Based on the source of the embolus, septic pulmonary embolism (SPE) can be classified as cardiac, peripheral endogenous, or exogenous. Cardiac SPEs are the most common.

We conducted a retrospective analysis of 20 patients with cardiac SPE hospitalized between 1991 and 2013 at a Chinese tertiary referral hospital.

The study included 14 males and 6 females with a median age of 38.1 years. Fever (100%), cough (95%), hemoptysis (80%), pleuritic chest pain (80%), heart murmur (80%), and moist rales (75%) were common clinical manifestations. Most patients had a predisposing condition: congenital heart disease (8 patients) and an immunocompromised state (5 patients) were the most common. Staphylococcal (8 patients) and Streptococcal species (4 patients) were the most common causative pathogens. Parenchymal opacities, nodules, cavitations, and pleural effusions were the most common manifestations observed via computed tomography (CT). All patients exhibited significant abnormalities by echocardiography, including 15 patients with right-sided vegetations and 4 with double-sided vegetations. All patients received parenteral antimicrobial therapy as an initial treatment. Fourteen patients received cardiac surgery, and all survived.

Among the 6 patients who did not undergo surgery, only 1 survived. Most patients in our cardiac SPE cohort had predisposing conditions. Although most exhibited typical clinical manifestations and radiography, they were nonspecific. For suspected cases of SPE, blood culture, echocardiography, and CT pulmonary angiography (CTPA) are important measures to confirm an early diagnosis. Vigorous early therapy, including appropriate antibiotic treatment and timely cardiac surgery to eradicate the infective source, is critical.

No MeSH data available.


Related in: MedlinePlus