SESSION TITLE: Fellows Chest Infections Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: October 18-21, 2020 INTRODUCTION: Septic pulmonary embolism (SPE) is a known disorder that typically presents with fever, hemoptysis and cough. Embolic sources vary and thus classification of SPE can be divided into cardiac, peripheral endogenous, or exogenous. A severe complication of infective endocarditis (IE) is organ embolization which can wreak havoc on multiple different organs/organ systems. The cumbersome part about establishing a diagnosis is due to the vagueness of symptoms at presentation. Patients often present with fever, malaise and respiratory symptoms. On the other hand, typical CT chest findings are multiple, bilateral and peripherally distributed pulmonary nodules/cavitations. We present a case of septic pulmonary emboli to the right lung only. CASE PRESENTATION: A 64 y/o M with a PMH of schizophrenia, COPD, chronic oropharyngeal dysphasia with PEG tube in place and history of PE who presented to the ER from his nursing home for the evaluation of hypotension. The patient was admitted to the ICU for the evaluation and management of septic shock thought to be secondary to aspiration pneumonia. The patient was initially treated with broad-spectrum antibiotics and after his blood cultures grew MRSA he had a CT scan of the chest which showed multiple right-sided nodules without cavitation. A TEE Was performed and showed evidence of a right atrial mass 2 cm in the largest diameter. The patient remained on long term IV Vancomycin for MRSA endocarditis. DISCUSSION: SPE remains a clinical challenge for the clinician. As symptoms remain vague and non-specific recent studies have shown that fever remains the lead symptom present in virtually all patients with SPE, cough (up to 95% of cases) and hemoptysis (up to 80% of cases) should insinuate the presence of SPE. The diagnostic criteria for SPE per Cook’s definition are as follows 1. Focal or multifocal lung infiltrates compatible with septic embolism in the lung according to ventilation-perfusion (V/Q) scan plus chest CT and/or CT pulmonary angiography (CTPA) 2. The presence of active extrapulmonary infection as a potential embolic source 3. Exclusion of other potential explanations 4.Resolution of lung infiltrates with appropriate antimicrobial therapy CONCLUSIONS: Cardiac SPE remains a diagnostic challenge to the clinician however with modified Cook’s criteria as detailed above can hint towards the correct diagnosis. CT scan of the chest with or without contrast remains of paramount importance in diagnosing septic emboli and provides the most accurate tool to hint towards diagnosis. Blood cultures are almost always positive in patients with SPE and rapid timely recognition is very essential in the treatment and better prognosis. Reference #1: 1. Cook RJ, Ashton RW, Aughenbaugh GL, et al. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 2005; 128:162–166. Reference #2: 2. Lee SJ, Cha SI, Kim CH, et al. Septic pulmonary embolism in Korea: microbiology, clinicoradiologic features, and treatment outcome. J Infect 2007; 54:230–234. Reference #3: Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009; 30:2369–2413. DISCLOSURES: No relevant relationships by Hussein Asad, source=Web Response No relevant relationships by Ashraf Gohar, source=Web Response No relevant relationships by Rahul Myadam, source=Web Response