History of IV Drug Abuse and Hemoptysis

Jonathan Gordon, M.D., Ph.D.

July 14, 2004

Discussion

Patients with septic pulmonary emboli typically present with fever, cough and hemoptysis and have a classic history of intravenous drug abuse, tricuspid valve endocarditis or infected central venous catheters. Additional associated conditions include immunologic deficiency, cutaneous infection, upper extremity or pelvic venous infection or infected arteriovenous fistulas. Streptococcus or Staphylococcus aureus are the most commonly isolated organisms. This case illustrates classic radiologic findings of septic emboli including peripheral nodules of various sizes and varying degrees of cavitation. Septic emboli may be unilateral only and may wax and wane as embolic showers occur. Infectious foci may extend into the pleural space and result in an empyema. On CT, an additional classic sign is the "feeding vessel sign", when nodules arise distally along a pulmonary vessel. A major potential complication is that of pulmonary infarction presenting as a triangular wedge-shaped opacity which displays peripheral enhancement and central low attenuation or nonenhancement. An unusual cause of septic emboli is that of a pharyngeal or parapharyngeal space infection extending into the internal jugular vein, known as Lemierre syndrome. This patient was found to have tricuspid endocarditis.

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