Tuberc Respir Dis.  2010 Aug;69(2):124-128.

A Case of Septic Pulmonary Embolism Associated with MRSA Infective Endocarditis

• Lee KJ
• Kim NY
• Kim JS
• Yun HK
• Oh MJ
• Kim DH
• Cho SK
• Ryu HY
• Bae YA
• Kim DB
• Shin MK
• Chin JY

Abstract

Septic pulmonary embolism is the process in which an infected thrombus becomes detached from its site of origin and lodges in a pulmonary artery, and is usually associated with infective endocarditis, especially right-sided, or infection-associated with indwelling catheters, peripheral septic thrombophlebitis, and periodontal diseases, etc. Here, we report a case of septic pulmonary embolism associated with tricuspid valve infective endocarditis. A 23-year-old female was admitted to our hospital, due to fever, sore throat, and myalgia. In her past medical history, she had undergone a surgical operation for closure of a ventricular septal defect, but was informed that the operation resulted in an incomplete closure. The initial chest radiograph demonstrated multiple rounded, parenchymal nodules in various sizes; several nodules had central lucency suggesting cavitations. Echocardiography demonstrated a large vegetation attached to the septal tricuspid valve leaflet, extending from right ventricular inflow tract to outflow tract. Computed tomography of thorax revealed bilateral peripheral nodules and wedge-shaped consolidation at various sizes, mostly accompanied by cavitations.

Keyword

Pulmonary Embolism; Endocarditis; Methicillin-Resistant Staphylococcus aureus

MeSH Terms

Catheters, Indwelling
Echocardiography
Endocarditis
Female
Fever
Heart Septal Defects, Ventricular
Humans
Methicillin-Resistant Staphylococcus aureus
Periodontal Diseases
Pharyngitis
Pulmonary Artery
Pulmonary Embolism
Thorax
Thrombophlebitis
Thrombosis
Tricuspid Valve
Young Adult

Figure

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  Figure 1 The chest radiograph shows multiple cavitary nodules (arrows) in both lungs. Also note parenchymal consolidation in right lower lung zone.

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  Figure 2 (A) The chest CT scan reveals bilateral peripheral nodules and wedge-shaped consolidation with various size. Some of the lesions show connection with pulmonary vessels (so-called feeding vessel sign, arrows), and this suggests septic emboli. Also note right pleural effusion. (B) The coronal reformatted CT image shows multiple nodules and areas of consolidation in almost all lobes. These parenchymal lesions are mainly located in peripheral lungs and connected with pulmonary vessels (arrows).

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  Figure 3 Transverse contrast-enhanced CT scan (mediastinal window setting) shows cardiomegaly and large filling defect in right ventricle (arrow), which is declared later as vegetation attached to septal tricuspid valve leaflet on echocardiographic examination.

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  Figure 4 Echocardiogram shows a huge vegetation (41.0×18.4 mm) (arrow) attached to right ventricular side of septal tricuspid valve leaflet, extending from right ventricular inflow track to outflow tract (parasternal short axis view, arrow). LA: left atrium; RV: right ventricle; RA: right atrium.

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  Figure 5 Gross findings of abnormal tissue resected by surgery (size 4×2.5×2 cm) showing irregularly shaped lesions (vegetation) (arrow head) attached to relatively smooth surfaced portion (diseased valve) (arrow).

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