Actual aspects of radiological diagnosis of septic pulmonary embolism
https://doi.org/10.24835/1607-0763-1107
Abstract
Aim. To form for viewers an actual vision of the issue of septic pulmonary embolism in the terminological, morphological and clinical aspects, as well as presentation of the methodic of medical imaging of such patients, to systematize and illustrate the main and rare CT signs of septic embolism.
Materials and methods. We analyze the data of national and foreign scientific papers for 2001-2021 on the platforms PubMed, Elibrary, etc., as well as earlier "classic" publications on sepsis, infectious endocarditis and septic pulmonary embolism. Also presents own experience of practice with such patients in multidisciplinary hospitals and typical cases, taking into account more than 5 years of experience on this topic in radiology departments in cooperation with related specialists (cardiologists, therapists, purulent surgeons, morphologists).
Results. 52 of the most relevant scientific papers were selected from 162 available articles. Based on the results, a review was compiled on the peculiarities of terminology, epidemiology, etiology, clinical presentations, as well as methods for diagnosis of septic pulmonary embolism, CT signs of verified cases during primary scanning, as well as follow-up images, which is extremely important in differential diagnosis. The part with the pathological anatomy of septic embolism makes it possible to better understand CT signs and the difference between this process from ordinary pneumonia.
Conclusion. Due to the fact that septic embolism is a secondary process, the correct and quick interpretation of the CT images initiates the search for the primary purulent source of embolism in the body, and follow-up CT-scans (especially in infectious endocarditis) allows you to assess the effectiveness of therapy.
About the Authors
A. S. Vinokurov
Pirogov Russian National Research Medical University of the Ministry of Health of Russia;
Demikhov City Hospital of Moscow City Health Department;
Moscow Multidisciplinary Clinical Center “Kommunarka” of Moscow City Health Department
Russian Federation
Russian Federation
Anton S. Vinokurov – assistant professor of radiology department, Pirogov Russian national research medical university; radiologist of MRI and CT departments, Demikhov City Hospital and radiology department MMCC «Kommunarka»
Ostrovityanov str., 1, Moscow 117997;
Shkuleva str., 4, Moscow 109263;
Sosenskiy stan str., 8, Moscow 108814, Kommunarka
O. I. Belenkaya
Pirogov Russian National Research Medical University of the Ministry of Health of Russia;
Demikhov City Hospital of Moscow City Health Department
Russian Federation
Russian Federation
Olga I. Belenkaya – Cand. of Sсi. (Med.), Associate Professor of radiology department, Pirogov Russian national research medical university; head of MRI and CT department, Demikhov City Hospita
Ostrovityanov str., 1, Moscow 117997;
Shkuleva str., 4, Moscow 109263
A. L. Yudin
Pirogov Russian National Research Medical University of the Ministry of Health of Russia
Russian Federation
Russian Federation
Andrey L. Yudin – Doсt. of Sсi. (Med.), Professor, head of radiology department
Ostrovityanov str., 1, Moscow 117997
References
1. Dunaev A.P., Sheikh Zh.V., Karmazanovsky G.G., Drebushevsky N.S. Radiology diagnostics of acute destructive inflammatory processes in the lungs. M.: Publishing House Vidar-M, 2016. 104 p. (In Russian)
2. Bone R.C. Toward an Epidemiology and Natural History of SIRS. JAMA. 1992; 268: 3452–3455.
3. Sepsis at the beginning of the XXI century. Classification, clinical and diagnostic concept and treatment. Pathoanatomic diagnostics: A practical guide. Moscow: Publishing House of the A.N. Bakulev NCSSH RAMS, 2004. 130 p. (In Russian)
4. Kozlov V.K. Sepsis, severe sepsis, septic shock: pathogenetic justification of the diagnosis, clinical interpretation, principles and methodology of diagnosis. Clinical and Laboratory Consultation. 2014; 2 (49): 20–40. (In Russian)
5. Ustyantseva I.M., Khokhlova O.I., Petukhova O.V. et al. Criteria of systemic inflammatory response syndrome (SIRS) in early diagnosis of sepsis in patients with polytrauma. Polytrauma. 2010; 1: 13–16. (In Russian)
6. Rozhkov A.S., Lebedev V.F., Kobiashvili M.G. Sepsis. Selected issues of therapy of infectious patients / Under the general editorship of Yu.V. Lobzin. SPb.: Folio, 2005: 855–879. (In Russian)
7. Singer M., Deuschman C.S., Seymour C.W. et al. The Third International Consensus definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016; 315 (8): 801–810.
8. Rudnov V.A., Kulabukhov V.V. Sepsis-3: updated key provisions, potential problems and practical steps. Bulletin of Anesthesiology and Reanimatology. 2016; 13 (4): 4–11. (In Russian)
9. Vincent J.L., Opal S.M., Marshall J.C. et al. Sepsis definitions: time for change. Lancet. 2013; 381 (9868): 774–775.
10. Yapalova K.S., Zhmurov V.A., Rogozhkina Yu.A. Septic pneumonia in infectious endocarditis. University Medicine of the Urals. 2019; 2: 46–47. (In Russian)
11. Chipigina N.S., Kulichenko V.P., Vinogradova T.L., Bolshakova M.A. Lung damage in infectious endocarditis. The Clinician. 2008; 2: 28–33. (In Russian)
12. Ulanova V.I., Mazurov V.I. Infectious endocarditis in people with drug addiction: clinical and morphological features and results of conservative therapy. Bulletin of the St. Petersburg Academy of Postgraduate Education. 2010; 4 (2): 43–47. (In Russian)
13. Demko I.V., Pelinovskaya L.I., Mankhayeva M.V. et al. Features of infective endocarditis in injection drug users. Russian Journal of Cardiology. 2019; 24 (6): 97–102. https://doi.org/10.15829/1560-4071-2019-6-97-102 (In Russian)
14. Chipigina N.S., Karpova N.Yu., Belova M.V., Savilov N.P. Infective endocarditis: diagnostic difficulties. The Clinician. 2020; 14 (1–2): 82–90. https://doi.org/10.17650/1818-8338-2020-14-1-2-82-90 (In Russian)
15. Alieva A.M., Reznik E.V., Nikitin I.G. et al. A clinical case of infectious aortic valve endocarditis in an elderly patient. Lechebnoe delo. 2018; 2: 114–119. https://doi.org/10.24411/2071-5315-2018-12010 (In Russian)
16. Voitsekhovskiy V.V., Korzhova N.V., Goborov N.D. et al. Lung damage in patients with drug addiction. Bulletin of Physiology and Pathology of Respiration. 2018; 68: 79–91. https://doi.org/10.12737/article_5b19d77f5e9a60.82681424 (In Russian)
17. Taradin G.G., Ignatenko G.A., Rakitskaya I.V. et al. Practical aspects of infective endocarditis prevention. Cardiovascular Therapy and Prevention. 2021; 20 (2): 2564. https://doi.org/10.15829/1728-8800-2021-2564 (In Russian)
18. Inchaustegui C.A., Wang K.Y., Teniola O., Rosen V.L. Large septic pulmonary embolus complicating streptococcus mutans pulmonary valve endocarditis. Radiology Case. 2018; 12 (2): 18–27. https://doi.org/10.3941/jrcr.vl2i2.3240
19. Chou Deng-Wei, Wu Shu-Ling, Chung Kuo-Mou et al. Septic pulmonary embolism requiring critical care: clinicoradiological spectrum, causative pathogens and outcomes. CLINICS. 2016; 71 (10): 562–569. https://doi.org/10.6061/clinics/2016(10)02
20. Balandina I. A., Pastukhov A.D., Nagaev A. S., Balandin V.A. Radiological signs of acute inflammatory diseases of the thorax in HIV-infected patients. The Successes of Modern Science. 2016; 12 (5): 61–64. (In Russian)
21. Osipova E.D., Osipov A.O., Polyanina O.V. et al. Features of the course of infectious endocarditis in HIV-infected patients, diagnosis and treatment. Scientific Almanac. 2017; 5–3 (31): 206–214. https://doi.org/10.17117/na.2017.05.03.206 (In Russian)
22. Song X., Li S., Cao J. et al. Cardiac septic pulmonary embolism. A retrospective analysis of 20 cases in a Chinese population. Medicine. 2016; 95: 25.
23. Twito J., Sahra S., Jahangir A. et al. A curious case of MRSA bacteremia and septic pulmonary embolism secondary to peripheral venous catheter. Case Rep. Crit. Care. 2021; article ID 5544505, 4 pages. https://doi.org/10.1155/2021/5544505
24. Baklaushev V.P., Kulemzin S.V., Gorchakov А.А. et al. COVID-19. Etiology, Pathogenesis, Diagnosis and Treatment. Journal of Clinical Practice. 2020; 11 (1): 7–20. https://doi.org/10.17816/clinpract26339 (In Russian)
25. Rogani S., Calsoralo V., Franchi R. et al. Spontaneous muscle hematoma in older patients with COVID-19: two case reports and literature review. BMC Geriatrics. 2020; 20: 539. https://doi.org/10.1186/s.12877-020-01963-4
26. Danilov A.I., Abramenkova N.Yu., Milyagin V.A. Modern methods of visualization of the lesion of the valvular apparatus of the heart in infectious endocarditis. A Difficult Patient. 2019; 10 (17): 10–12. https://doi.org/10.24411/2074-1995-2019-10068 (In Russian)
27. Mendez-Echevarria A., Coronado-Poggio M., BaqueroArtigao F. et al. Septic pulmonary emboli detected by 18@F-FDG PET/CT in children with S. aureus catheterrelated bacteremia. Infection. 2017; 45 (5): 691–696. https://doi.org/10.1007/s15010-017-0992-5
28. Gomes A., Glaudemans A. W., Touw D. J. et al. Diagnostic value of imaging in infective endocarditis: a systematic review. Lancet Infect. Dis. 2017; 17 (1): e1–14. https://doi.org/10.1016/S1473-3099(16)30141-4
29. Purulent diseases of the pleura and lungs / Ed. By Kupriyanov P.A. L.: Medgiz, 1955. 506 p. (In Russian)
30. Ojeda Gómez J.S.A., Carrillo Bayona J.A., Morales Cifuentes L.C. Septic pulmonary embolism secondary to Klebsiella pneumoniae epididymitis: case report and literature review. Case Rep. Radiol. 2019; 2019: 5395090. https://doi.org/10.1155/2019/5395090
31. Huang R-M., Naidich D. P., Lubat E. et al. Septic pulmonary emboli: CT-radiographic correlation. Am. J. Roentgenol. 1989; 153: 41–45.
32. Lee S.J., Weon Y.C., Cha H.J. et al. A case of atypical skull base osteomyelitis with septic pulmonary embolism. J. Korean Med. Sci. 2011; 26: 962–965. https://doi.org/10.3346/jkms.2011.26.7.962
33. Mustafa Mahmood Eid. Infective endocarditis with embolic renal infarct presenting as acute abdomen. Clin. Exp. Emerg. Med. 2021; 8 (2): 145–148. https://doi.org/10.15441/ceem.20.037
34. Parkhomenko Yu.G., Zairatiants O.V., Makarova O.V. Sepsis. Infectious endocarditis. Etiology, pathogenesis, classification, pathological anatomy. M.: MDV Group, 2013. 104 p. (In Russian)
35. Bogatov A.I., Mustafin D.G. Complicated staphylococcal pneumonia in adults. M.: Medicine. 1984. 175 p. (In Russian)
36. Hussain S.T., Witten J., Shrestha N.K. et al. Tricuspid valve endocarditis. Ann. Cardiothorac. Surg. 2017; 6 (3): 255–261. https://doi.org/10.21037/acs.2017.03.09
37. Lobzin A.V., Levina A.S. Clinical masks of infectious endocarditis. Journal of Infectology. 2015; 2 (7): 14–20. (In Russian)
38. Almeida R.R., Marchiori E., Flores E.J. Frequency and reliability of the reversed halo sign in patients with septic pulmonary embolism due to IV substance use disorder. Am. J. Roentgenol. 2020; 214: 1–9. https://doi.org/10.2214/AJR.19.21659
39. Hong G., Kim Y.S. Recurrent septic pulmonary embolism related to an implanted central venous access port device. Chin. Med. J. 2018; 131: 3009–3011. https://doi.org/10.4103/0366-6999.247196
40. Jing J., Qiu-li L., Li-hua L. et al. Septic pulmonary embolism in China: clinical features and analysis of prognostic factors for mortality in 98 cases. BMC Infectious Diseases. 2019; 19: 1082. https://doi.org/10.1186/s12879-019-4672-1
41. Kotova E.O., Domonova E.A., Kobalava Zh.D. et al. Modern trends in identification of causative agents in infective endocarditis. Rational Pharmacotherapy in Cardiology. 2021; 17 (1): 153–164. https://doi.org/10.20996/1819- 6446-2021-02-14 (In Russian)
42. Iwasaki Y., Nagata K., Masaki N., Natuhara A. et al. Spiral CT findings in septic pulmonary emboli. Eur. J. Radiol. 2001; 37: 190–194.
43. Sukhova M.B., Medvedev А.P. Early Сontrast-Enhanced Multispiral Computed Tomographic Diagnosis of Septic Pulmonary Embolism and a Case of Successful Surgical Treatment. Journal of Radiology and Nuclear Medicine. 2019; 100 (5): 304–308. https://doi.org/10.20862/0042-4676-2019-100-5-304-308 (In Russian)
44. Veras R.O., Barasuol L.L., de Lira C.P. et al. Lemierre syndrome: case report. J. Vasc. Bras. 2018; 17 (4): 337–340. https://doi.org/10.1590/1677-5449.002418
45. Medina F., Tatay M., Smati M. et al. Lemierre’s syndrome: an unusual presentation. Med. Mal. Infect. 2015; 45 (8): 328–330. https://doi.org/10.1016/j.medmal.2015.05.009
46. Kuhlman J.E., Fishman E.K., Teigen C. Pulmonary septic emboli: diagnosis with CT. Radiology. 1990; 174: 211–213.
47. Vinokurov A.S., Smirnova A.D., Belenkaya O.I., et al. Clinical and radiological variants of lung damage in infection caused by Staphylococcus aureus. Clinical Practice. 2021; 12 (3): 71–89. https://doi.org/10.17816/clinpract71642 (In Russian)
48. Okabe M., Kasai K., Yokoo T. Pneumothorax secondary to septic pulmonary emboli in a long-term hemodialysis patients with psoas abscess. Intern. Med. 2017; 56: 3243–3247. https://doi.org/10.2169/internalmedicine.9050-17
49. Medvedev A.P., Fedorov S.A., Pichugin V.V. et al. Catheterinduced infectious endocarditis complicated by pulmonary embolism: successful surgical treatment. Grekov's Bulletin of Surgery. 2020; 179 (3): 85–90. https://doi.org/10.24884/0042-4625-2020-179-3-85-90 (In Russian)
50. Oh G. H., Cha S.-I., Shin K.-M. et al. Risk factors for mortality in patients with septic pulmonary embolism. J. Infect. Chemoter. 2016; 22: 553–558. https://doi.org/10.106/j.jiac.2016.05.008
51. Vinokurov A.S., Yudin A.L., Belenkaya O.I. CT-semiotics of septic pulmonary embolism and its complications. Medical Visualization. 2018; 22 (6): 23–32. https://doi.org/10.24835/1607-0763-2018-6-23-32 (In Russian)
52. Galili Y., Lytle M., Carlan S., Madruga M. Bilateral pneumothoraces: a rare complication of septic pulmonary emboli in intravenous drug abusers. Am. J. Case Rep. 2018; 19: 829–832. https://doi.org/10.12659/AJCR.91037
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For citations:
Vinokurov A.S., Belenkaya O.I., Yudin A.L. Actual aspects of radiological diagnosis of septic pulmonary embolism. Medical Visualization. 2022;26(4):44-59. (In Russ.) https://doi.org/10.24835/1607-0763-1107
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