Septic Pulmonary Embolism

¹ Associate Professor of Medicine, and Director, Medical In-Patient Service
² Associate Professor of Radiology

Seven patients with septic pulmonary embolism (SPE) are presented. Four, two of whom were heroin addicts, had staphylococcal tricuspid endocarditis. Three had suppurative pelvic thrombophlebitis. Dominant clinical findings were shaking chills, high fever, and marked sinus tachycardia. Chest roentgenograms demonstrated significant parenchymal disease in each case and provided the first clue to the true nature of the illness in four. Lung scans and pulmonary arteriograms were done in two patients. The scan in both cases showed decreased radioactivity over regions of lung containing large parenchymal infiltrates, while the arteriogram was normal in one and revealed occlusion of numerous segmental arteries in the other. Four patients died. Of the survivors, one recovered after use of antimicrobial agents alone, while two required surgical intervention. When the source of infection remains obscure and signs of SPE persist despite seemingly adequate antibiotic therapy, management is difficult. If, in that circumstance, the patient is a man or a heroin addict of either sex, we recommend increasing the dose or changing the type of antibiotic(s). By contrast, if the patient is a woman and not a heroin addict, we favor ligation of the inferior vena cava and both ovarian veins.