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 We encountered three cases of septic pulmonary emboli(SPE).

 Case 1: a twenty-one-year-old female developed fever and tender swelling in the right side of her neck. Her blood culture produced Fusobacterium necrophorum. CT scan of her chest showed multiple necrotic infiltrates and neck CT scan showed lymphadenitis. She was diagnosed as SPE. She was treated successfully with a four-week course of antibiotics.

 Case 2: a sixty-year-old male underwent craniotomy for resection of a meningioma. After that, a central line in the left internal jugular vein had been inserted for total parenteral nutrition. He began to experience fever and positive blood culture of Candida albicans 1 month later. CT of his chest showed multiple infiltrates. CT of the neck showed thrombophlebitis in the left internal jugular and subclavian vein. Transesophageal echocardiography was negative for infectious endocarditis. These finding demonstrated SPE secondary to septic thrombophlebitis due to the central line. The catheter was removed and he was treated successfully with a 6-week course of fluconazole intravenously and anticoagulation.

 Case 3: a 60-year-old male with alcoholic liver cirrhosis was admitted to another hospital with fever and multiple joint pains. Blood culture was persistently positive for E.coli even after the initiation of antibiotic treatment. Therefore, he was transferred to our hospital. His chest X-ray and CT scan showed multiple infiltrates, which was consistent with SPE. To discover the etiology of SPE, echocardiography was performed. It showed tricuspid endocarditis. He was also found, by MRI and CT scan, respectively, to have osteomyelitis in the cervical vertebra and pelvic bone and an abscess in the right thigh. He was treated successfully with a 15-week course of antibiotics.

 Diagnosis of SPE is usually made by typical findings of chest X-ray and CT scan, including multiple infiltrates, feeding vessel sign, and cavitary formation. The source of SPE is tricuspid valve endocarditis, septic thrombophlebitis due to an intravenous catheter, illicit drug abuse, and neck infection. This is usually treated with antibiotics. Sometimes, surgical resetion of the infected vein or anticoagulation is necessary for septic thrombophlebitis. Drainage is sometimes required for an abscess. Therefore, it is important to identify the source of infection when SPE is diagnosed.


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電子版ISSN 1882-1200 印刷版ISSN 0452-3458 医学書院

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