Septic Pulmonary Embolism Research Articles

Late Manifestation of Congenital Heart Disease: Right-side Infective Endocarditis and the Mystery of the Unseen Ventricular Septal Defect: Case Report

Infective endocarditis (IE) is a severe complication in patients with congenital heart disease. However, CHD-associated mortality has decreased to 10% because of improvements in the diagnosis of infective endocarditis, antibiotic therapy, cardiac surgery, and interventional procedures. Herein, we aimed to illustrate a case of right-sided infective endocarditis associated with an unknown ventricular septal defect, complicated by septic pulmonary emboli as a rare form of delayed presentation of congenital heart disease.
 The significant occurrence of infective endocarditis prompts the need for additional investigations into the current utilization, necessity, and effectiveness of antibiotic prophylaxis in patients with congenital heart disease (CHD).

“ChatGPT, Can You Help Me Save My Child’s Life?” - Diagnostic Accuracy and Supportive Capabilities to Lay Rescuers by ChatGPT in Prehospital Basic Life Support and Paediatric Advanced Life Support Cases – An In-silico Analysis

BackgroundPaediatric emergencies are challenging for healthcare workers, first aiders, and parents waiting for emergency medical services to arrive. With the expected rise of virtual assistants, people will likely seek help from such digital AI tools, especially in regions lacking emergency medical services. Large Language Models like ChatGPT proved effective in providing health-related information and are competent in medical exams but are questioned regarding patient safety. Currently, there is no information on ChatGPT’s performance in supporting parents in paediatric emergencies requiring help from emergency medical services. This study aimed to test 20 paediatric and two basic life support case vignettes for ChatGPT and GPT-4 performance and safety in children.MethodsWe provided the cases three times each to two models, ChatGPT and GPT-4, and assessed the diagnostic accuracy, emergency call advice, and the validity of advice given to parents.ResultsBoth models recognized the emergency in the cases, except for septic shock and pulmonary embolism, and identified the correct diagnosis in 94%. However, ChatGPT/GPT-4 reliably advised to call emergency services only in 12 of 22 cases (54%), gave correct first aid instructions in 9 cases (45%) and incorrectly advised advanced life support techniques to parents in 3 of 22 cases (13.6%).ConclusionConsidering these results of the recent ChatGPT versions, the validity, reliability and thus safety of ChatGPT/GPT-4 as an emergency support tool is questionable. However, whether humans would perform better in the same situation is uncertain. Moreover, other studies have shown that human emergency call operators are also inaccurate, partly with worse performance than ChatGPT/GPT-4 in our study. However, one of the main limitations of the study is that we used prototypical cases, and the management may differ from urban to rural areas and between different countries, indicating the need for further evaluation of the context sensitivity and adaptability of the model. Nevertheless, ChatGPT and the new versions under development may be promising tools for assisting lay first responders, operators, and professionals in diagnosing a paediatric emergency.Trial registrationNot applicable.

Abstract 16065: AICD Lead Endocarditis With Large Vegetation Complicated by Septic Pulmonary Embolism

Introduction: Infective endocarditis of an automatic implantable cardioverter-defibrillator (AICD) lead is a rare and serious complication. Less than 4% of AICD related endocarditis cases are caused by Enterococcus faecalis . Herein, we report a rare case of a patient with an infected AICD lead and a large vegetation caused by Enterococcus faecalis . Case Presentation: A 66-year-old male with a history of mitral valve replacement, heart failure with reduced ejection fraction status post AICD and hypertension presented with loss of appetite, subjective fevers and chills. Initial vitas were significant for tachycardia and tachypnea. Physical examination revealed lethargy and an irregular rate and rhythm. Initial labs showed an elevated WBC count, elevated C-reactive protein, elevated D-dimer, negative procalcitonin, negative High-sensitivity troponins and elevated BNP. Electrocardiogram showed atrial fibrillation. Echocardiogram showed an EF of 25-30% with a vegetation on the right ventricular lead. A CT angiogram chest was done and showed a right pulmonary artery embolism. Blood cultures were positive for Enterococcus faecalis . The patient was started on IV antibiotics, anticoagulation and he underwent open removal of the AICD along with multiple vegetations with the largest being 3.5cm. He recovered well post-operatively. Discussion: Cardiac device endocarditis is a difficult to manage condition that has been increasing in incidence over the years. Persistent infection is a problem faced when a patient has AICD endocarditis since these infections are typically resistant to many antibiotics necessitating surgical removal of the AICD. Patients that present with large vegetations larger than 2.5cm are at highest risk of complications. These complications include septic pulmonary emboli as seen in our patient, pulmonary abscess formation and pneumonia. Early diagnosis and lead extraction has been related to the highest reduction in mortality.

A Case of a Home Hemodialysis Patient With Infective Endocarditis Complicated by Cerebral Infarction and Septic Pulmonary Embolism, Most Likely Caused by Frequent Shunt Punctures

We report a case of home hemodialysis with infectious endocarditis complicated by cerebral infarction and septic pulmonary embolism, most likely due to frequent shunt punctures. The patient, a 52-year-old man, was introduced to hemodialysis at our hospital 11 years ago due to reduced renal function caused by polycystic kidney disease and was transferred to home hemodialysis in the same year. Fever and general weakness appeared four days before he was urgently admitted to our department. Two blood culture sets revealed methicillin-susceptible Staphylococcus aureus (MSSA), brain MRI revealed multiple cerebral infarctions, and transesophageal echocardiography revealed infective endocarditis. The patient was transferred to the cardiology department of an affiliated hospital, treated with antimicrobials (for a total of 58 days), and discharged home on the 63rd day after admission. Frequent shunt punctures were considered to be the cause of the bloodstream infection leading to multiple complications.

Septic pulmonary emboli: a case discussion.

A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.

Isolated Pulmonary Valve Endocarditis on an Undiagnosed Congenital Heart Disease in a Young Adult: A Rare Clinical Entity

Background: Isolated pulmonary valve endocarditis (PVE) is a rare condition that accounts for 1.5–2% of all reported cases of endocarditis. Herein, we describe a rare case of isolated pulmonary valve endocarditis with a fortuitous discover of a congenital heart disease in a young adult subject. Unlike other cases of right sided endocarditis, we treated our patient both medically and surgically.
 Case Presentation: The patient was diagnosed with an isolated pulmonary valve endocarditis after blood cultures confirming the presence of Abiotrophia defectiva, a germ difficult to cultivate whilst the echocardiographic revealed a vegetation mass measuring 8mm long alongside with the discovery of a severe pulmonary valve stenosis and a large atrial septal defect (ASD) of 39mm wide. Septic pulmonary emboli were the first clinical manifestation in our patient. Both medical and surgical treatment was indicated based on dual antibiotics, removal of the vegetation, valvulotomy and closure of the ASD.
 Conclusion: Both medical and early surgery therapy should be considered in patient with right sided endocarditis associated with congenital heart disease for better clinical outcome.

A Rare Case of Postpartum Native Tricuspid Valve Infective Endocarditis with Septic Pulmonary Embolization

Infective endocarditis (IE) is a rare life-threatening infection in pregnancy and postpartum period. In 90% of cases, right-sided IE involves the tricuspid valve. This case report illustrates acute IE with native tricuspid valve vegetation with septic pulmonary embolization in immediate postpartum period.

Septic Embologenic Pneumonia — Clinical and Diagnostical Features (Review and Own Observations)

In contrast to trivial bacterial pneumonia, the diagnosis of septic pulmonary embolism poses a fundamental task for the doctor to search for primary sources of emboli, including right side infective endocarditis, and to change the tactics of managing the patient accordingly. The similarity of the main clinical common and respiratory symptoms of septic pulmonary embolism with symptoms of other inflammatory processes in the lung makes their differential diagnosis difficult without the involvement of additional radiologic investigation methods. The review describes the special features of etiology and pathogenesis, as well as the clinic, complications and principles of diagnosis of septic embolic pneumonia.

Septic Pulmonary Embolism Associated with Hemodialysis Catheter-Related Bloodstream Infection

The most common predisposing factor of septic pulmonary embolisms is the presence of an infected right atrial thrombus. Rarely, it may occur as a complication of catheter-related bloodstream infection (CRBSI). The usual presentation is with fever, chest pain, and variable degree of dyspnea. The condition warrants prompt removal of the catheter in combination with systemic antibiotics. The most common organism reported to cause septic pulmonary embolism is Staphylococcus aureus followed by streptococcus, and rarely, Gram-negative bacilli. We present a case of septic pulmonary embolism in an adolescent on maintenance hemodialysis through a right internal jugular tunneled cuffed catheter in whom the catheter tip thrombus was associated with CRBSI due to Esherichia coli.

Outcomes With Percutaneous Debulking of Tricuspid Valve Endocarditis.

In patients with tricuspid valve infective endocarditis, percutaneous debulking is a treatment option. However, the outcomes of this approach are less well known. We performed a retrospective analysis of all patients who underwent percutaneous vegetation debulking for tricuspid valve infective endocarditis from August 2020 to November 2022 at a large academic tertiary care public hospital. The primary efficacy outcome was procedural success defined by clearance of blood cultures. The primary safety outcome was any procedural complication. For the composite outcome of in-hospital mortality or heart block, outcomes were compared (sequential noninferiority and superiority) with published surgical outcomes data. Of the 29 patients with tricuspid valve infective endocarditis who underwent percutaneous debulking, the average age was 41.3±10.1 years, all patients had septic pulmonary emboli with 27 (93.1%) patients having cavitary lung lesions before the procedure. For the efficacy outcomes, 28 patients (96.6%) had clearance of cultures after their procedure, mean white blood cell count significantly decreased from 16.8±1.4×103 to 12.6±1.0×103 per µL (P<0.01), and mean body temperature significantly decreased from 99.8F ±0.30 to 98.3F ±0.20 (P<0.001) post-procedure. For safety outcomes, there were no procedural complications (0%). Two patients (6.9%) died during the follow-up period, both during the index hospitalization due to severe necrotizing pneumonia. When compared with published data on surgical outcomes, percutaneous debulking was noninferior and superior for the composite of in-hospital death or heart block (noninferiority, P<0.001; superiority, P=0.016). Percutaneous debulking is feasible, effective, and safe in treating patients with tricuspid valve infective endocarditis refractory to medical therapy.

P79 MITRAL VALVE ENDOCARDITIS COMPLICATED BY INFERIOR INFARCT AND MULTIPLE DISTAL EMBOLICATIONS

Abstract A 41–year–old woman with history of drug addiction was ammitted at emergency department (ED) with the following symptoms: hyperpyrexia, shaking chills asthenia and anorexia for about 10 days; the hematochemical tests performed in urgency showed an increasing inflammatory markers and severe anemia. On suspicion of infective endocarditis, a transthoracic echocadiogram was performed which revealed a mobile isoechoic mass adhered to the anterior mitral leaflet (LAM), compatible in the first hypothesis with endocardiac vegetation. Hemocultures were drawn and empiric antibiotic therapy was setted. Following clinical conditions’s worsening, the patient underwent contrast–free total body Computed Tomography (CT) with the detection of multiple pulmonary, splenic and renal septic emboli associated with a cerebral hemorrhagic focus. Transesophageal echocardiography (TEE) confirmed the presence of a 29 mm mobile vegetation on the atrial side of the LAM and the LAM’s perforation at the A3 level with associated severe eccentric regurgitation jet. Therefore, during hospitalization, coronary septic embolization was suspected due to the onset of a severe epigastric pain and the electrocardiographic finding of ST–elevation in the inferior leads associated with troponin’s increase. In consideration of the high bleeding risk and the septic state, conservative therapy was indicated. After a month of targeted antibiotic therapy, once clinical stabilization was obtained, a control TEE was performed and showed the disappearance of the endocardial vegetation and the persistence of the valve flap perforation and the eccentric jet. Once the regression of the septic state, a coronarographic study was performed and it showed no significant stenosis. The patient underwent mitral valve plastic surgery with the direct suture of the LAM and ring implantation in mini–thoracotomy. After a short period in intensive care, she continued her hospitalization in cardiac surgery department without complications. Careful clinical management of the acute phase and antibiotic therapy, empirical and targeted, allowed the patient to undergo cardiac surgery in the best possible conditions, reducing the risk of complications.

Baseline characteristics and analysis of predictors of the Outcome of septic pulmonary embolism in children: a retrospective observational study

BackgroundSeptic pulmonary embolism is a rare disease in children. We aimed to assess the clinical, microbiological, and radiological characteristics and outcomes of pediatric septic pulmonary embolism (SPE) and to identify any predictive factors for in-hospital mortality in patients with this unusual disease to enhance prognosis and treatment.MethodsA retrospective study to search the electronic medical records of children admitted to the pediatric pulmonology unit, Tanta University hospital with the diagnosis of SPE between January 2015 and June 2022.ResultsSeventeen pediatric patients were identified; ten males and seven females with a mean age of 9.4 ± 5.2 years. The most common presenting complaints were fever and shortness of breath (n = 17) followed by chest pain (n = 9), pallor (n = 5), limb swelling (n = 4), and back pain (n = 1). Methicillin-resistant Staphylococcus aureus (MRSA) was the most common causative pathogen in nine patients. The most common extra-pulmonary septic foci were septic arthritis in five patients (29.4%), septic thrombophlebitis in four patients (23.5%), and infective endocarditis in two patients (11.8%). All patients exhibited wedge-shaped peripheral lesions and feeding vessel sign in CT chest, whereas bilateral diffuse lesions, nodular lesions, and cavitation were present in 94.1% of patients, pleural effusion was identified in 58.8% of patients, and pneumothorax was detected in 41.2% of patients. Fifteen patients improved and survived (88.2%), while two patients died (11.8%).ConclusionEarly diagnosis of SPE with vigorous early therapy is critical for a better outcome, including appropriate antibiotics and timely surgical interference to eradicate extra-pulmonary septic foci.

PO-01-075 TRANSTHORACIC ECHOCARDIOGRAPHY FOR EARLIER DIAGNOSIS OF ATRIOESOPHAGEAL FISTULA AFTER ABLATION FOR ATRIAL FIBRILLATION

Atrioesophageal fistula (AEF) is a rare complication of radiofrequency ablation for atrial fibrillation (AF). Early diagnosis and surgical management are keys to mitigate progression of this often moribund complication. Although chest CT is the preferred first line imaging tool for diagnosis, AEF symptoms are often variable and counterintuitive which prompts the need to understand echocardiographic findings that may lead to an earlier diagnosis. To report the initial echocardiogram findings of two patients that were ultimately diagnosed with AEF. N/A A 79-year-old male with symptoms AF and gastroesophageal reflux underwent an uneventful pulmonary vein isolation (PVI). Approximately 3 weeks after the ablation, the patient presented to his local hospital with profound fatigue and was found to have nonspecific ST/T changes with an elevated troponin. The transthoracic echocardiogram (TTE) showed moderate left ventricular dysfunction and echo dense microbubbles in the left atrium and ventricle, but not in the corresponding right-sided chambers (Figure A). An emergent CT scan based upon the TTE showed an AEF and he underwent and emergent surgery to repair the AEF. A 49-year-old male underwent a PVI with additional targeting of regions of complex fractionated electrograms on the posterior wall. Two weeks later he developed worsening dyspnea on exertion and chest pain. A CT scan found multiple septic pulmonary emboli and a TTE noted a mobile density crossing the intra-atrial septum. During transfer to our center, he developed progressive respiratory failure and required intubation. Upon arrival he was found to have multiple embolic injuries to his brain and focal neurologic findings. A transesophageal echocardiogram (Figure B) confirmed the mobile density in the right atrium that was an extension of a lesion originating from the posterior left atrium and extending to the iatrogenic atrial septal defect. AEF requires very early diagnosis for survival. In the setting of often non-specific symptoms, such as in these two cases that can lead to an initial incorrect diagnosis, the TTE provided key information to support the underlying diagnosis and guide expedited work-up and intervention.

Comment on: Dialysis catheter-related sepsis resulted in infective endocarditis, septic pulmonary embolism and acute inferolateral STEMI: a case report.

Comment on: Dialysis catheter-related sepsis resulted in infective endocarditis, septic pulmonary embolism and acute inferolateral STEMI: a case report.

Mechanical extraction of a pulmonary valve vegetation in a patient with endocarditis.

A 44-year-old male known with small ventricular septal defect, but no previous history of intravenous drug abuse presented to an outside hospital with fever, chills, and back pain. A chest computed tomography showed multifocal nodular and consolidative pulmonary opacities with borderline enlarged mediastinal lymph nodes (Panel, A). Blood cultures grew Staphylococcus lugdunensis; given suspicion of infective endocarditis causing septic pulmonary emboli, he was transferred to our hospital. Transoesophageal echocardiography (TEE) on admission showed highly mobile masses attached to the native tricuspid (B) and to the sub-pulmonary area of the right ventricular outflow tract along with posterior leaflet perforation of the tricuspid valve with mild-to-moderate regurgitation (C). The sub-pulmonary lesion was in the path of the high-velocity left-to-right jet through the ventricular septal defect (D; Supplementary data online, Video S1), explaining the unusual location. Patient had persistent bacteremia despite appropriate antibiotic therapy and eventually developed haemoptysis and acute respiratory failure requiring intubation. At repeat TEE showed interval increase in the size of the sub-pulmonic vegetations. In the absence of haemodynamically significant lesions, the multidisciplinary team recommended percutaneous transcatheter mechanical vegectomy rather than surgical intervention.

Septic Cavernous Sinus Thrombosis in a Young Male Presenting With Pneumothorax Secondary to Septic Pulmonary Emboli: A Case Report

Septic pulmonary embolism (SPE) is a rare complication that happens when infected thrombi from the original site of infection break off and travel to the pulmonary blood vessels, causing an infarction or an abscess. Cases were reported on SPE, with tricuspid or pulmonary valve endocarditis being the most common primary site, especially in intravenous drug abusers. There are, however, very few reports of SPE brought on by septic cavernous sinus thrombosis (CST). Here, we describe the case of an 18-year-old male who had a pustule on his left eyelid, after which he developed fever, spontaneous swelling of his left eye, followed by his right eye, along with bilateral proptosis and diplopia, and new-onset dyspnea. Auscultation revealed decreased breath sounds in the left lung fields. Magnetic resonance imaging (MRI) revealed cavernous sinus thrombosis. Blood cultures isolated Staphylococcus aureus species. High-resolution computed tomography (HRCT) revealed a left-sided pneumothorax with minimal pleural effusion and multiple nodules scattered among both lungs, suggesting septic pulmonary emboli. We report this case to convey how a minor lesion, that is, an eyelid pustule (stye), can get complicated and set off a spiral of events that takes an unexpected tangent, challenging physicians and necessitating a rigorous approach.

Erratum: Septic Pulmonary Embolism. A Contemporary Profile.

Correction to: Septic Pulmonary Embolism. A Contemporary ProfileSemin Thromb Hemost eFirstDOI: 10.1055/s-0042-1758742

Acute Pulmonary Embolism with Multiple Septic Emboli and Pulmonary Infarcts in an IV Drug Abuser with Right-Sided Endocarditis: A Case Report

This case report describes the imaging findings of septic pulmonary embolism (SPE) in a 30-year-old male with a history of intravenous drug abuse for one year. The patient initially presented with high grade fever, shortness of breath, and cough in the emergency department of our institution. The patient was evaluated by chest X-ray, blood cultures, echocardiography, and CT pulmonary angiography which confirmed the diagnosis of SPE, and the causative organism was confirmed to be Staphylococcus aureus. In this case report, we discuss the Chest X-ray findings, and characteristic CT imaging findings of SPE and describe the role of different imaging modalities in the timely diagnosis and management of this highly fatal condition.

Mystery in the Air: A Case Report of Emphysematous Pyelonephritis Presenting as Subcutaneous Emphysema and Septic Pulmonary Embolism

ABSTRACT We report a patient with uncontrolled type 2 diabetes mellitus who was found to have subcutaneous emphysema on examination. Left-sided emphysematous pyelonephritis (EPN) due to Escherichia coli was identified as the cause of this finding. Further evaluation revealed that she had septic emboli in the lungs, which was also likely to be due to EPN. This case report highlights the possibility that EPN may present as a subcutaneous emphysema. This also reports the occurrence of septic embolism in EPN.

Septic pulmonary embolism: Is it an underestimated diagnosis?

Septic pulmonary embolism: Is it an underestimated diagnosis?