Spe can be defined as a thrombus containing microorganisms embedded in fibrin that moves from an infectious focus and settles in pulmonary arteries. Nonthrombotic pulmonary embolism ntpe is defined as embolisation to the pulmonary circulation of different cell types adipocytes, haematopoietic, amniotic, trophoblastic or tumour, bacteria, fungi, foreign material or gas. Septic pulmonary embolism spe is an uncommonly reported complication of ie requiring a high index of suspicion. A septic embolus is a type of infection inside a blood vessel. Konstantinides, md, phd, a,b stefano barco, md, mareike lankeit, md,a guy meyer, mdc abstract pulmonary embolism pe remains a major contributor to global disease burden. Previously, septic embolism was almost exclusively a complication of septic pelvic thrombophlebitis secondary to both septic abortion. Septic pulmonary embolism spe is a rare type of pulmonary embolism in which emboli containing pathogens embolize to the pulmonary artery and cause pulmonary embolism and focal lung abscesses. It is however extremely difficult to isolate the causative pathogen of periodontal diseaseassociated spe from blood cultures of these patients. Clinical characteristics of septic pulmonary embolism in adults. In 1978, a study 1 reported 60 cases of spe, 78% of these were intravenous drug users 1. To characterize the presenting features and clinical course of patients with spe. Cxr chest radiograph, spe septic pulmonary embolism septic pulmonary embolism spe is an uncommon disorder that generally presents with an insidious onset of fever, respiratory symptoms, and lung infiltrates. Septic pulmonary embolism pe typically presents with fever, cough, and haemoptysis. Ct features of septic emboli included multiple peripheral nodules ranging in size from 0.
Grampositive cocci, including methicillinsusceptible staphylococcus aureus and methicillinresistant staphylococcus aureus, are the most common causative organisms of spe. Endocarditis, lemierres syndrome, lung infection, pulmonary embolism, septic thrombophlebitis, staphylococcus. An infected clot, or a small fragment of a clot, becomes dislodged and comes to rest at a distal location. Blood clots most often originate in the legs and travel up through the right side of the heart and into the lungs. Original article clinical and radiographic spectrum of. Few case reports have been published on spe caused by pseudomonas aeruginosa p. This term specifically refers to an infection that started in one part of the body and traveled through blood vessels to reach another part of the body, possibly blocking one or more blood vessels.
Characteristic radiologic features may permit early, correct diagnosis. Esc guidelines on acute pulmonary embolism diagnosis and. Case reports septic pulmonary embolism secondary to. For example, in one series of postmortem examinations in japan, 2. Lowlevel softtissue infection can be a potential source.
Jul 24, 2014 septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies. Septic pulmonary embolism spe is an uncommon disorder that generally presents with an insidious onset of fever, respiratory symptoms, and lung infiltrates. Septic pulmonary emboli and bacteremia associated with deep. Nonthrombotic pulmonary embolism is uncommon, and the precise incidence varies among studies and according to the underlying cause. The increase in dead space and reduction in endtidal co 2 etco 2 in pulmonary embolism. The association of septic thrombophlebitis with septic pulmonary. Pulmonary embolism symptoms and causes mayo clinic. Septic pulmonary embolism spe is a rare type of pulmo nary embolism in which emboli containing pathogens embolize to the pulmonary artery. Septic pulmonary embolism spe is uncommon but associated with high mortality.
Septic pulmonary emboli are most commonly encountered in the setting of septicemia due to rightsided bacterial endocarditis figure 4, infected central venous catheters, periodontal infections, septic thrombophlebitis, and prosthetic vascular devices. It can result in the spread of infection to a distant site. Septic pulmonary embolism associated with selfinflicted. Septic pulmonary embolism due to periodontal disease. Associations and outcomes of septic pulmonary embolism article pdf available in the open respiratory medicine journal 81. Approximately one third of first vte presentations are due to pe while the remainder. Septic pulmonary embolism associated with selfinflicted wound. When reporting septic embolisms, you must know whether the cardiologist documented the embolism as arterial or pulmonary. Introduction septic pulmonary embolism spe is a rare condition that occurs in the lungs in the presence of a primary focus of infection such as oropharyngeal region infections, central venous catheter thrombophlebitis, right heart endocarditis, and intravenous iv drug usage.
To report septic arterial embolisms, look to icd10 code i76. To investigate the clinical features of septic pulmonary embolism spe cases and prognostic factors for inhospital mortality in china. The clinical symptoms depend on the size and location of the embolus. Causes include fractures of long bones, orthopedic procedures, microvascular occlusion or necrosis of bone marrow in patients with sickle cell crisis, and, rarely, toxic modification of native or parenteral serum lipids. Septic pulmonary embolism spe is an uncommon disease without a specific clinical presentation and may present with an insidious onset of fever, cough or. Septic embolism definition of septic embolism by medical. A 15 year old girl presented with fever, extremity swelling and.
Septic thrombophlebitis, septic pulmonary emboli, anticoagulation. The hospital admits a 46yearold chain smoker with fever, shortness of breath, and pulmonary infiltrates, one of which has a small cavity in it. The diagnosis is based on the presence of certain risk factors such as intravenous drug use, tricuspid valve bacterial endocarditis, thrombophlebitis, indwelling catheters. Nonthrombotic pulmonary embolism pulmonary disorders. Pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs.
Septic pulmonary embolism due to periodontal disease spepd is rarely reported and little is known about its clinical features. Pulmonary embolism can be grouped based on the location of clot or how sick a person is. Early diagnosis and prompt administration of antibiotics are crucial in patients with septic pulmonary emboli. Intravenous drug use, in particular, increases the risk of a harmful infection that can cause endocarditis or septic emboli. Patients with septic pulmonary emboli usually present with fever, cough, and hemoptysis. Septic embolism is a relatively common and potentially severe complication of infective endocarditis ie. For several decades, lowmolecularweight heparin or unfractionated heparin followed by oral vitamin k antagonists have been the conventional. Mdct of pulmonary septic embolism chest imaging original research highresolution mdct of pulmonary septic embolism.
Venous thromboembolism vte is a common disease, affecting approximately 12 in 1,000 adults per year. Clinical presentation symptoms can be not specific but most manifest. The patients lacked evidence of rightsided endocarditis or thrombophlebitis. Many recommendations have been retained or their validity has been reinforced. Septic pulmonary emboli refer to the embolization of infectious particles intravascular thrombus containing microorganisms into the lungs via the pulmonary arterial system. This association, previously described in children, may also be.
To provide an evidencebased approach to treatment of patients with acute pulmonary embolism pe. Staphylococcus aureus infective endocarditis and septic pulmonary embolism after septic abortion. An embolism made up of purulent matter that arises from the site of an infection caused by a pyogenic pusforming organism. Aslam af, ahmad ka, thakur ct, vasavada bc, khan ia. To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital. Jan 21, 2019 septic pulmonary embolism spe is a rare disorder that generally presents with an insidious onset of fever, respiratory symptoms, and lung infiltrates. The purpose of this article is to describe the clinical signs, pathogenesis, diagnosis and treatment of the different ntpe subtypes. A pulmonary embolism pe is a blood clot that gets into blood vessels in the lungs and prevents normal flow of blood in that area. Computed tomography ct showed bilateral, multiple lung nodules of.
Septic pulmonary embolism spe is an uncommon but serious complication resulting from infection of the blood. A retrospective analysis was conducted of spe patients hospitalized between january 2007 and june 2018 in the department of respiratory and critical care medicine, the first affiliated hospital of guangxi medical university. Fat embolism is caused by introduction of fat or bone marrow particles into the systemic venous system and then into pulmonary arteries. A septic embolism is a type of embolism that is infected with bacteria, resulting in the formation of pus. Original article clinical and radiographic spectrum of septic. Associations and outcomes of septic pulmonary embolism.
Septic pulmonary embolism associated with periodontal. The left side pulmonary aneurysms are likely to be infective as the patient had no history of any sort of vasculitis or pulmonary hypertension. Septic emboli can occlude or damage virtually any vessel in the systemic or pulmonary arterial circulation. Few case reports have been published on spe caused by pseudomonas. Clinical and radiographic spectrum of septic pulmonary. Nonthrombotic pulmonary embolism european respiratory. Pulmonary embolism occurs when a blood clot gets lodged in an artery in the lung, blocking blood flow to part of the lung. We report four adult patients who presented with septic pulmonary emboli and communityacquired methicillinresistant staphylococcus aureus bacteremia associated with deep tissue infections, such as pyomyositis, osteomyelitis, and prostatic abscess. There are some lifestyle factors that are known to contribute to the risk of septic embolus. The blood flow from these areas leads directly to the lungs, where a detached clot can lodge in the pulmonary arteries. Previously, septic embolism was almost exclusively a complication of septic pelvic thrombophlebitis secondary to both septic abortion and postpuerperal uterine infection. Based on location of the clot into pulmonary artery following terms are used a saddle pe large clot into main pulmonary artery, b lobar pe into big branch of pulmonary artery, or c distal pe into small branches of. Cuenza2 1department of adult cardiology, philippine heart center, philippines 2department of adult cardiologyinvasive cardiology and cardiac rehabilitation, philippine heart center, philippines corresponding author.
Typically, when iv drug use is the cause of septic embolus, it begins when bacteria on the skin enter the body and cause an. You may also have pain, redness and swelling in 1 of your legs. Spe is usually associated with tricuspid valve infectious endocarditis ie, infected central venous catheters, septic thrombophlebitis including lemierres syndrome, and skin and soft tissue. Septic pulmonary embolism chest journal american college of. You must also carefully read and follow all notes related to these embolism codes in the icd10 manual. Staphylococcus aureus is cultured from the blood, and the pulmonologist diagnoses tricuspid endocarditis.
Septic pulmonary embolism in a child indian pediatrics. Septic pulmonary emboli and bacteremia associated with. Septic pulmonary embolism spe is an infective pulmonary disease that develops secondary to any source of infection and presents with signs and symptoms such as pulmonary infiltrates, fever, chest pain, and cough. The purpose of this study was to evaluate the clinical and radiological features, as well as outcome, in spepd. Careful analysis of risk factors aids in diagnosis. We report a 21yearold male, former methamphetamine user, complaining of intermittent fever, cough and. Vasculitis introduction septic pulmonary embolism spe is an uncommon but potentially fatal complication of infective endocarditis ie. Septic pulmonary emboli radiology reference article. Septic embolism is another special disorder that, unfortunately, is also increasing in frequency owing to widespread injection drug use and the expanding use of indwelling intravenous catheters. Septic pulmonary embolism spe is an uncommon syndrome characterized by embolization of infected thrombi from a primary infectious site into the venous circulation with implantation into pulmonary vasculature resulting in parenchymal infection. Pdf we present three cases of septic pulmonary embolism which occurred as a result of three different causes.
Septic emboli come from a site of infection, where bacteria are present in large numbers and various inflammatory processes and turbulent blood flow increase the likelihood of clot formation. Anticoagulant treatment for acute pulmonary embolism. In a the alveoli and their capillaries have normal ventilation and perfusion, respectively. Pediatricians should consider septic pulmonary embolism in cases of septic deep venous thrombosis even in the absence of respiratory symptoms. One of the common microbes that can lead to widespread dissemination of septic emboli is fusobacterium necrophorum, a gram negative anaerobic. Periodontal disease, including periodontitis, has been reported to be a rare cause of septic pulmonary embolism spe. In this study, an 85yearold japanese man was admitted with fever and worsening malaise. Riskadapted treatment and followup contributes to a favorable outcome. Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies. Request pdf septic pulmonary embolism in a child septic pulmonary embolism pe is a diagnosis seldom considered in children. Septic pulmonary embolism spe is an uncommon disease without a specific clinical presentation and may present with an insidious onset of fever, cough or hemoptysis. Management of pulmonary embolism an update stavros v.
All but one patient received parenteral antimicrobial therapy. Septic pulmonary embolism secondary to staphylococcus aureus septic thrombophlebitis in a pediatric patient farah c. Overview of infected mycotic arterial aneurysm view in chinese rightsided native valve infective endocarditis view in chinese. In the proper clinical setting, characteristic ct features of septic emboli can suggest the correct diagnosis. Anticoagulation is the mainstay for the treatment of acute pulmonary embolism. Chapter 16 pulmonary embolism 169 the greatest risk of pulmonary embolism occurs when a clot has formed in the thighs or pelvis. Complete occlusion of the right pulmonary artery is suggestive of chronic pulmonary embolism rather than acute form. However, this condition is often challenging to diagnose in the absence of a heart murmur or a positive blood culture. Clots in the veins of the calves or arms, however, may also be associated with pulmonary embolism. The authors conclude that ct is an important modality for confirming the presence of pulmonary septic emboli even when conventional chest radiographs remain negative. Septic pulmonary embolism associated with periodontal disease.
Pdf associations and outcomes of septic pulmonary embolism. Retrospective analysis of patients in a tertiary paediatric facility in northern taiwan. Nonthrombotic pulmonary embolism european respiratory society. Pulmonary embolism hellenic journal of cardiology hjc n 95 etco240 etco220 40 40 0 40 47 40 40 47 47 ab figure 1. Clinical and radiographic spectrum of septic pulmonary embolism. A rare and cataclysmic complication of infective endocarditis emily mae l. Nonthrombotic pulmonary embolism is infrequently visualized at imaging. Septic pulmonary embolism spe is an uncommon disorder with an insidious onset and is difficult to diagnose. Pulmonary embolism is a common disease with an estimated incidence of 12 per annually in the general population. Apr 10, 2019 pulmonary embolism refers to the obstruction of the pulmonary artery or one of its branches by a thrombus that originates somewhere in the venous system or in the right side of the heart. A pulmonary embolism is a blocked blood vessel in your lungs. This document follows the previous esc guidelines focusing on the clinical management of pulmonary embolism pe, published in 2000, 2008, and 2014.
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