HEMATOGENOUS PULMONARY NODULES

Septic pulmonary embolism is an uncommon disorder that is most often seen in patients with predisposing situations (intravenous drug use, endocarditis, septic thrombophlebitis, central venous catheter infections…). The clinical signs are non-specific. CT scan is useful for diagnosis showing bilateral pulmonary nodules with some orienting signs. We report a case of a 43-year-old woman, with a history of hemodialysis via a tunneled jugular catheter, who presented with acute respiratory distress and fever, chest CT showed multiple bilateral nodules, some of which are excavated. Blood cultures showed a staphylococcus aureusbacteremia. The diagnosis of septic emboli was made in view of all the clinical, biological, and radiological elements.

Septic Pulmonary Embolism Causing Recurrent Pneumothorax in an Intravenous Drug User without Right-Sided Valvular Vegetation in Infective Endocarditis

The following report illustrates a case of a 36-year-old Caucasian male with intravenous drug use (IVDU) induced septic thrombophlebitis presenting with recurrent unilateral pneumothoraces from septic pulmonary embolism (SPE) without the presence of obvious right-sided valvular vegetation in infective endocarditis (IE), defined as tricuspid or pulmonary valve lesions. Pneumothorax (PTX) has been observed as a rare complication of SPE and is commonly associated with infective right-sided IE, IVDU, and intravascular indwelling catheters. However, this case is novel as it is the very rare documented case of recurrent, unilateral, spontaneous right PTX refractory to multiple chest tube placements in such a setting. Therefore, the absence of detectable right-sided valvular vegetation in IE does not obviate the risk of SPE-induced PTX in IVDU and further expands the realm of infectious and pulmonary consequences of SPE and IVDU.

Prognostic Value of Cardiac Troponin I In Infective Endocarditis

Aim The aim of this study is to assess the prognostic value of cardiac troponin I as a predictor of in-hospital morbidity and mortality in patients with infective endocarditis. Methods This study included 48 patients with definite and possible IE according to modified Duke’s criteria for diagnosis of IE. This prospective longitudinal study was conducted on patients admitted to the cardiovascular department of Cairo University hospitals. All patients were subjected to full history taking and clinical examination, all laboratory and radiological investigations which included chest radiography, echocardiogram and other diagnostic procedures as needed for diagnosis and follow-up of IE were done with emphasis on cardiac troponin I level on admission. Results Troponin I was found to be statistically significant predictor for heart failure (NYHA III/IV), septic pulmonary embolism and in-hospital mortality in infective endocarditis patients by univariate and multivariate regression analysis with P values 0.023, 0.037and 0.002 respectively. Tricuspid valve vegetations had showed significant relation to troponin I levels with p value 0.033. Also it was found that SOFA score on first day of admission showed significant relation to troponin I level with P value 0.045 and 0.004 for prediction of hospital stay duration. Shock and intracranial hemorrhage showed borderline significance with P values 0.097, 0.069. On other hand, troponin I as predictor of pulmonary edema, mechanical complications, systemic embolization, acute kidney injury and presence of aortic root abscess had no statistical significance in our studied patients. Conclusions This study showed that there is as significant predictive value of elevated cardiac troponin I with heart failure, septic pulmonary embolism and all cause in-hospital mortality. In addition, it was significant predictor of the length of hospital stay, lymphocytosis and SOFA score. These results are emphasizing that cTn I level may predict higher risk patients who would need early and aggressive control of infection medically alone or combined with surgery in IE patients.

Clinical and radiological variants of lung damage in infection caused by Staphylococcus aureus

Despite the high level of modern technologies in the field of laboratory methods and imaging of the respiratory system, the problem of early and accurate differential diagnosis of inflammatory lung diseases remains important in practical medicine. It leads to improved treatment results and a reduction in the number of complications (pleural empyema, fistulas, mediastinitis, sepsis, etc.), and in some cases allows to suspect the presence of a primary purulent source in the body, as in the case of septic pulmonary embolism. The review examines the features of S. aureus as a pathogen of lung diseases, relevant epidemiology, pathogenesis, clinical features and imaging diagnostics of various types of inflammatory changes in the lungs with a focus on destruction.

Extensive right-sided infectious endocarditis due to Streptococcus pneumoniae

Streptococcus pneumoniae is a rare cause of infectious endocarditis. Most cases have an acute and aggressive evolution, with a high mortality rate. We report the case of a 36-year-old man, with a history of unrepaired ventricular septal defect, who came to the emergency department with fever, cough and asthenia with 3 months of evolution. Blood cultures were positive for Streptococcus pneumoniae. Echocardiogram showed large vegetation on septum, free wall and outflow tract of the right ventricle. Thoracic CT revealed septic pulmonary embolism. Antimicrobial therapy and surgical treatment was performed and the patient presented a favourable evolution.