Septic pulmonary embolism in a child

Septic pulmonary embolism (PE) is a diagnosis seldom considered in children. A 15 year old girl presented with fever, extremity swelling and pain for 5 days. Chest radiograph revealed a large, round density in the right lung and consolidation areas in peripheral portions of both lungs. Computed tomography showed bilateral multiple round and cavitary nodules in peripheral portions of both lungs, pleural effusion in the right lung and hypodense round lesion (8 cm by 4 cm) in the superior segment of right lower lobe, characteristic of PE. Cefotaxime and clindamycin were administered. By the 5th hour, the patient passed away. Staphylococcus aureus was isolated from blood, pleural fluid and tracheal aspirate cultures.