A 30 year old female with a history of IV drug use presents with 2 weeks of progressively worsening right sided pleuritic chest pain, productive cough, and shortness of breath. A chest x-ray is shown below. What’s the diagnosis?
Answer: Cavitary lesion with air-fluid level consistent with abscess from septic emboli secondary to infective endocarditis
Etiology: Bacteria laden clots from right sided bacterial endocarditis, septic thrombophlebitis, periodontal, and central venous catheter infections. In IVDU, the tricuspid valve is most commonly involved with the most common pathogen being Staph aureus
Presentation: Pleuritic chest pain, cough, fever, hemoptysis
Differential for lung abscesses: Septic emboli, Tuberculosis, Aspergillosis, Granulomatosis with Polyangitis, Sarcoidosis, malignancy
Diagnosis: Chest x-ray, CT chest, blood cultures, echocardiogram
Treatment: Typically 2-8 weeks of IV antibiotics with possible abscess drainage +/- heart valve replacement
References:
Stawicki SP, Firstenberg MS, Lyaker MR, et al. Septic embolism in the intensive care unit. Int JCrit Illn Inj Sci. 2013;3(1):58-63. doi:10.4103/2229-5151.109423
Parkar AP, Kandiah P. Differential Diagnosis of Cavitary Lung Lesions. J Belg Soc Radiol.2016;100(1):100. Published 2016 Nov 19. doi:10.5334/jbr-btr.1202
