Associations and Outcomes of Septic Pulmonary Embolism



Umesh Goswami*, 1, Jorge A Brenes 2, Gopal V Punjabi 3, Michele M LeClaire 4, David N Williams 5
1 Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, MN, USA
2 Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
3 Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
4 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
5 Division of Infectious Diseases, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MN, USA


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© Goswami et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA; Tel: 612-646-1146; E-mail: goswa009@umn.edu


Abstract

Background:

Septic pulmonary embolism is a serious but uncommon syndrome posing diagnostic challenges because of its broad range of clinical presentation and etiologies.

Objective:

To understand the clinical and radiographic associations of septic pulmonary embolism in patients presenting to an acute care safety net hospital.

Methods:

We conducted a retrospective analysis of imaging and electronic health records of all patients diagnosed with septic pulmonary embolism in our hospital between January 2000 and January 2013.

Results:

41 episodes of septic pulmonary embolism were identified in 40 patients aged 17 to 71 years (median 46); 29 (72%) were men. Presenting symptoms included: febrile illness (85%); pulmonary complaints (66%) including pleuritic chest pain (22%), cough (19%) and dyspnea (15%); and those related to the peripheral foci of infection (24%) and shock (19%). Sources of infection included: skin and soft tissue (44%); infective endocarditis (27%); and infected peripheral deep venous thrombosis (17%). 35/41 (85%) were bacteremic with staphylococcus aureus. All patients had peripheral nodular lesions on chest CT scan. Treatment included intravenous antibiotics in all patients. Twenty six (63%) patients required pleural drainage and/or drainage of peripheral abscesses. Seven (17%) patients received systemic anticoagulants. Eight (20%) patients died due to various complications.

Conclusion:

The epidemiology of septic pulmonary embolism has broadened over the past decade with an increase in identified extrapulmonary, non-cardiac sources. In the context of an extrapulmonary infection, clinical features of persistent fever, bacteremia and pulmonary complaints should raise suspicion for this syndrome, and typical findings on the chest CT scans confirm the diagnosis. Antibiotics, local drainage procedures and increasingly, anticoagulation are keys to successful outcomes.

Keywords: Endocarditis, Lemierre’s syndrome, lung infection, pulmonary embolism, septic thrombophlebitis, Staphylococcus..