[Septic pulmonary embolism in intravenous drug users]

To analyze the characteristics of septic pulmonary embolism (SPE) in intravenous drug users.

The clinical manifestations, radiographic findings, bacteriology, echocardiography and outcome of intravenous drug users were analyzed retrospectively.

Twenty-two patients were identified with SPE between January of 1994 and December of 2006. Presenting symptoms included fever (22/22), dyspnea (20/22), pleuritic chest pain (10/22), cough (18/22), and hemoptysis (8/22). Chest radiographic features included nodular (15/22) and focal (12/22) infiltrates, wedge-shaped lesions (5/22), cysts (18/22), cavities (11/22), and pleural lesions (11/22). Peripheral or subpleural zones were most commonly affected (20/22). CT was more helpful and revealed multiple air cysts or nodules peripherally, often with cavitation. Staphylococcus aureus was the aetiological pathogen in all patients. Tricuspid valve vegetations were detected in all patients. Aside from antimicrobial therapy, the management included mechanical ventilation, control of shock and tube thoracostomy. Most patients recovered from their illness.

SPE manifests with variable and often nonspecific clinical and radiographic features. The diagnosis is usually suggested by the presence of a predisposing factor, fever, and radiographic findings of multiple, peripheral or subpleural air cysts, or nodules with or without caritation. With early diagnosis, appropriate antimicrobial therapy, and control of the infectious source, resolution of the illness can be expected for most patients.