Presentation
Facial cellulitis with MRSA bacteremia. Septic symptoms. ?endocarditis
Patient Data
The frontal chest x-ray demonstrates multiple faint bilateral rounded pulmonary opacities, the most conspicuous in the right upper zone and left lower zone posterior to the cardiac silhouette. Abnormalities are difficult to appreciate on the lateral x-ray, however the right upper lobe lesion is faintly visible.
No pleural effusions. The cardiomediastinal contour appears normal.
CT confirms the presence of bilateral pulmonary nodules, distributed throughout all zones of the lungs with a peripheral predominance. Lesions are solid with a ground glass halo. Some demonstrate central necrosis (best demonstrated on the soft tissue window as central low density).
Regions of smooth interlobular septal thickening in the right upper lobe, lingula and anterobasal left lower lobe.
Small left pleural effusion.
Case Discussion
Bilateral septic emboli were unexpectedly discovered in this patient who presented with bacteremia secondary to a facial abscess. At the time the initial x-ray was obtained, the patient did not report any respiratory symptoms.
Even extensive bilateral pulmonary emboli may be faint and difficult to detect on initial radiograph, despite their clear appearance on CT. This chest x-ray was initially reported as normal by the treating team.
The ground glass halo surrounding the nodules seen on CT may relate to inflammation or hemorrhage.
Unable to process the form. Check for errors and try again.