Allergy Asthma Respir Dis.  2017 Jan;5(1):56-60. 10.4168/aard.2017.5.1.56.

Septic pulmonary embolism resulting from soft tissue infection in a 5-year-old child

• Gil L
• Jeong K
• Kim HG
• Lee HD
• Cho JH
• Lee S

• KMID: 2368578
• DOI: http://doi.org/10.4168/aard.2017.5.1.56

Abstract

Septic pulmonary embolism occurs when septic material becomes detached from its origin and infiltrates into the pulmonary parenchyma causing significant clinical symptoms. It is uncommon in children and mostly related to intravascular catheterization, endocarditis, pelvic thrombophlebitis, and soft tissue infection. We report a case of a 5-year-old boy who experienced septic pulmonary embolism originating from a left shoulder abscess after traumatic injury. Magnetic resonance imaging of the shoulder revealed a multifocal subcutaneous and intramuscular abscess with septic arthritis. The initial chest radiograph showed suspicious pneumonic infiltration with nodular opacities. A percutaneous catheter was inserted to drain the shoulder abscess, and cefazedone, a first-generation cephalosporin, was administered intravenously. Two days later, a chest radiograph taken for the follow-up of the initial pneumonic infiltration with nodular opacities demonstrated aggravation of multifocal nodular lesions in bilateral lung fields, with one of the nodular cavities containing an air-fluid level. Despite the absence of significant respiratory symptoms, chest computed tomography showed multifocal necrotic nodules and cavity lesions with feeding vessel signs dominantly in the left lower lung field, which is characteristic of septic pulmonary embolism. Methicillin-susceptible Staphylococcus aureus was isolated from the shoulder abscess, whereas repeated blood and sputum cultures did not reveal any bacterial growth. With resolution of clinical symptoms as well as the finding of chest computed tomography, the patient was discharged 18 days after admission in a stable condition. Regression of the multifocal pulmonary nodular lesions was noticed on the subsequent chest imaging studies performed 45 days after the treatment.

Keyword

Pulmonary embolism; Soft tissue infection; Septic arthritis; Staphylococcus aureus; Child

MeSH Terms

Abscess
Arthritis, Infectious
Catheterization
Catheters
Child*
Child, Preschool*
Endocarditis
Follow-Up Studies
Humans
Lung
Magnetic Resonance Imaging
Male
Pulmonary Embolism*
Radiography, Thoracic
Shoulder
Soft Tissue Infections*
Sputum
Staphylococcus aureus
Thorax
Thrombophlebitis

Figure

• 

  Fig. 1 Magnetic resonance imaging of the left shoulder. Coronal (A) and axial (B) images are showing the large and multifocal intramuscular wall enhancing fluid collection suggestive of abscesses (white arrows). Septic arthritis was also noted in the left shoulder joint (not shown).

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  Fig. 2 Initial chest radiograph (A) showing suspicious pneumonic infiltration with nodular opacities on both lung fields (distinct semicircular shadow are unrelated detail) and 3 days later follow-up chest radiograph (B) demonstrating aggravation of multifocal nodular lesions in both lung fields, with one of the nodular cavities containing an air-fluid level (white arrow)

• 

  Fig. 3 Initial chest computed tomography (CT) images (A, B) are showing multifocal necrotic nodules at subpleural areas of the both lungs (black arrows) with feeding vessel sign (C, white arrow). (D–F) Forty-five days later follow-up chest CT images are showing nearly resolved pulmonary nodules.

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