Pediatric Septic Pulmonary Emboli

  • Etiology:
    — Hematogenous spread to pulmonary artery end arteries from endocarditis, infected central lines, periodontal disease
    — Organisms include Klebsiella, Staphylococcus aureus, Pseudomonas, E.coli, Fusobacterium leading to internal jugular vein septic thrombophlebitis = Lemierre Syndrome
  • Imaging: Pulmonary nodules that are wedge-shaped with ground glass halo or fluffy margins and cavitation
  • Note: Always look in jugular veins for source
  • DDX:
  • Complications:
  • Treatment:
  • Clinical: If history of pharyngitis consider Lemierre syndrome

Radiology Cases of Septic Pulmonary Emboli

CXR and CT of septic emboli in the lungs / septic pulmonary emboli
CXR AP (above) shows prominence of the central pulmonary arteries and multiple round lesions of varying size throughout both lungs which on the axial CT with contrast of the chest (below) are shown to have indistinct margins.

Radiology Cases of Septic Pulmonary Emboli Due to Lemierre Syndrome

US of Lemierre syndrome
Axial CT without contrast of the chest (above) shows multiple cavitary nodules within the lungs bilaterally. Sagittal spectral doppler US of the left internal jugular vein (below) shows thickening of the wall of the vein and no flow within.