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대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesArchive of Old Cases

Case No : 69 Date 1999-02-20

  • Courtesy of Duk Sik Kang, M.D. / Kyungpook National University Hospital
  • Age/Sex 42 / M
  • Chief ComplaintPainful neck swelling with mild fever for several days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Septic Embolism
Radiologic Findings
Chest radiograph shows multiple, poorly-defined nodular opacities in peripheral portion of both lungs. Costophrenic angles are blunted bilaterally. CT scans show wedge-shaped triangular opacities abutting the pleural surfaces with or without cavitation. Sizable amount of pleural effusion is seen bilaterally.
Brief Review
Septic pulmonary emboli reach the lung from a variety of sources, including infected heart valves, peripheral sites of septic thrombophlebitis, indwelling venous catheters or some other known source of sepsis. The common CT appearance in patients with pulmonary emboli is peripheral nodules in varying stages of cavitation, presumably due to intermittent seeding of the lungs by infected sources. The other finding would be identifiable feeding vessels in association with peripheral nodules. Although a common finding, the feeding vessel sign is not of itself a specific finding for septic pulmonary emboli. It has been reported in pulmonary metastases and it simply indicates the hematogenous origin of the parenchymal nodules. It should be noted that septic emboli may be mimicked either by a vasculitis, such as Wegener's granulomatosis, or cavitary metastases. In these cases, however, confusion with septic emboli, in particular, is rare because there may be differences in clinical presentations.
References
1. Huang RM, Naidich DP, Lubat E, Schinella R, Garay SM, McCauley DI. Septic pulmonary emboli: CT-radiographic correlation. AJR 1989;153:41-45
2. Kuhlman JE, Fishman EK, Teigen C. Pulmonary septic emboli: Diagnosis with CT. Radiology 1990;174:211-213
Keywords
Lung, Infection,

No. of Applicants : 26

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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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