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. 2002 Oct;87(4):312–315. doi: 10.1136/adc.87.4.312

Clinical and radiographic spectrum of septic pulmonary embolism

K Wong 1, T Lin 1, Y Huang 1, S Hsia 1, P Yang 1, S Chu 1
PMCID: PMC1763061  PMID: 12244005

Abstract

Aims: To review the clinical presentation, radiographic findings, and outcome of therapy in children with septic pulmonary embolism.

Methods: Retrospective analysis of patients in a tertiary paediatric facility in northern Taiwan.

Results: Ten children were identified with septic pulmonary emboli in a four year retrospective chart review between 1998 and 2001. Seven were immunocompetent, two were premature infants, one had ß thalassemia major. Seven had community acquired staphylococcal infections and bacteraemia, of which six were methicillin resistant Staphylococus aureus (MRSA) isolates. Five had soft tissue infections, two bone infections, one suppurative otitis media, one catheter related infection, and one unknown foci of infection. Multiple and bilateral nodular pulmonary parenchymal lesions were common on plain chest radiographs, but chest computed tomography scans showed the additional findings of a "vessel sign" and central cavitations, confirming the existence of septic pulmonary embolism.

Conclusions: Community acquired MRSA infections occurred in seven patients with septic pulmonary embolism but without predisposing high risk factors. Critically ill children with skin, soft tissue, or bone infections, when associated with septic pulmonary embolism in an area with a high rate of MRSA, should be empirically treated with glycopeptides (such as vancomycin or teicoplanin) before susceptibility results are known, in order to minimise morbidity and avoid mortality.

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Figure 1 .

Figure 1

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(A) Posteroanterior chest radiograph shows ill defined areas of consolidation in peripheral portions of both lower lobes (case 1). (B) CT section below carina. Scattered nodules in both solid and cavitations, most of which are compatible with haematogenous seeding (case 1).

Figure 2 .

Figure 2

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(A) Frontal chest radiograph shows large sized cavitations on both lung fields (case 10). (B) Chest CT axial view shows bilateral lung abscesses with air–fluid level (case 10). (C) Large pneumatocoele in the left lung noted two months after discharge (case 10).

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