Associations and outcomes of septic pulmonary embolism

Umesh Goswami, Jorge A. Brenes, Gopal V. Punjabi, Michele M. Leclaire, David N. Williams

Research output: Contribution to journalArticle

20 Citations (Scopus)

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. Key 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.

Original languageEnglish (US)
Pages (from-to)28-33
Number of pages6
JournalOpen Respiratory Medicine Journal
Volume8
Issue number1
DOIs
StatePublished - Jan 1 2014

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Pulmonary Embolism
Drainage
Fever
Thorax
Safety-net Providers
Infection
Anti-Bacterial Agents
Lung
Electronic Health Records
Bacteremia
Endocarditis
Chest Pain
Cough
Venous Thrombosis
Dyspnea
Anticoagulants
Abscess
Staphylococcus aureus
Shock
Epidemiology

Keywords

  • Endocarditis
  • Lemierre’s syndrome
  • Lung infection
  • Pulmonary embolism
  • Septic thrombophlebitis
  • Staphylococcus

Cite this

Associations and outcomes of septic pulmonary embolism. / Goswami, Umesh; Brenes, Jorge A.; Punjabi, Gopal V.; Leclaire, Michele M.; Williams, David N.

In: Open Respiratory Medicine Journal, Vol. 8, No. 1, 01.01.2014, p. 28-33.

Research output: Contribution to journalArticle

Goswami, Umesh ; Brenes, Jorge A. ; Punjabi, Gopal V. ; Leclaire, Michele M. ; Williams, David N. / Associations and outcomes of septic pulmonary embolism. In: Open Respiratory Medicine Journal. 2014 ; Vol. 8, No. 1. pp. 28-33.
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AB - 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. Key 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.

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