Septic Embolism – MD Nexus

Epidemiology

Incidence: increasing frequency (due to increasing use of indwelling catheters/devices and increasing incidence of IV drug abuse)

Endocarditis (Right-Sided) (see Endocarditis)
- Embolism from right-sided valvular vegetations
IV Drug Abuse
- Most common etiology
- Direct embolism of foreign material to pulmonary circulation from injection site
Obstetric-Gynecologic Procedures
- Embolism from pelvic vein injection
Pelvic Vein Thrombophlebitis (due to septic abortion and post-partum uterine infection)
- Was previously the most common etiology, prior to the current era of IVDA and increasing CVC use
- Emboli from pelvic veins
Chronic Central Venous Catheter (see Central Venous Catheter)
- Common etiology
- Embolism from material on line
Chronic Indwelling Vascular Devices
- Embolism from material on device
Lemierre’s Syndrome (see Lemierre’s Syndrome)
- Embolism from internal jugular vein thrombophlebitis

Purulent material with fibrin thrombus is embolized to lungs
Small pulmonary vessel obstruction by septic emboli can occur (however, major consequence is usually infection, not obstruction)

Sputum GS/C+S
CXR/Chest CT Patterns
- Multiple Pulmonary Nodules/Nodular Infiltrates
  - Location: typically lower zone predominance
  - Shape: typically 2-4 cm (round, wedge-shaped, or ill-defined nodules)
  - Calcification: none
  - Cavitation: common (usually thin-walled) -> nodules may evolve over hours-days and may form lung abscesses
V/Q Scan
Pulmonary Angio
Blood C+S: variably positive
- Usually diagnostic of endocarditis, Lemierre’s syndrome

Endocarditis (see Endocarditis): may occur with or may complicate septic embolism