Tx and Followup:
shunt replacement, exahastive search for other sources and appropriate antimicrobial therapy
Septic pulmonary embolism occur when an infected thrombus fragments and an emboli colonized with bacteria or fungi lodges in the pulmonary arterial circulation. Common sources septic thrombi include vegetative endocarditis and septic thrombophlebitis. Other less common sources include infected transvenous pacemakers, catheters, or shunts.
Organisms most commonly associated with septic pulmonary embolism include, Staphylococcus aureus and group A Streptococcus. However many patients, especially Intravenous drug abusers may harbor polymicrobial emboli, including anaerobic and gram-negative organisms. Blood cultures may be falsely negative, particularly early in the disease process.
Patients with septic pulmonary emboli have varied presentations depending upon the organism and the underlying disease. A high level of clinical suspicion is necessary given most often only non specific signs and symptoms including fevers, chills, nausea, vomiting, anorexia, cough, dyspnea or pluritic chest pain are obvious.
The classic plain film findings of septic pulmonary emboli include multiple pulmonary nodules of variable size with or without cavitation, located predominantly in the periphery and bases. However, most radiographs reveal only ill-defined infiltrates and effusions.
CT is the preferred imaging technique for septic pulmonary emboli. The presence of cavitating nodules with associated feeding vessels in highly specific for septic pulmonary emboli.