Clinical Images  |   December 2020
Septic Pulmonary Emboli With Feeding Vessel Sign
Author Notes
  • From the Department of Internal Medicine at Michigan State University and Sparrow Hospital in East Lansing, Michigan. 
  • Financial Disclosures: None reported. 
  • Support: None reported. 
  •  *Address correspondence to: Tyler Kemnic, DO, Michigan State University Clinical Center, 788 Service Rd, Room B-301, East Lansing, MI, 48824-7013. Email:
Article Information
Clinical Images   |   December 2020
Septic Pulmonary Emboli With Feeding Vessel Sign
The Journal of the American Osteopathic Association, December 2020, Vol. 120, 942. doi:
The Journal of the American Osteopathic Association, December 2020, Vol. 120, 942. doi:
A 42-year-old woman with emphysema and a history of intravenous drug abuse and smoking presented to the emergency department for shortness of breath. She had a 2-week duration of dyspnea at rest, a left foot wound, and fevers. Initial vital signs were 103.8˚F, 139 bpm, and 60 rpm. She required supplemental oxygen. Physical examination revealed diffuse bilateral wheezes and a left foot abscess. Blood cultures and polymerase chain reaction revealed methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Chest computed tomography angiography demonstrated diffuse bilateral pulmonary cavitation with the dominant lesion having a feeding vessel sign (image). The patient was diagnosed with MRSA endocarditis on echocardiogram with septic pulmonary emboli. Vancomycin was administered; however, the patient needed to be intubated. Lymphatic drainage was contraindicated in the patient because of the risk of systemic infection, bacteremia, and possible further dislodging emboli.1 Due to further decompensation, the family chose to pursue comfort care measures. 
A septic pulmonary embolism is a blood vessel that is obstructed, usually by an infected thrombus. The pathogenesis consists of an embolic or ischemic event followed by an infection causing inflammation, which may form an abscess.2 Abscesses are most commonly caused by staphylococcal species, especially from infective endocarditis.3 On imaging, the “feeding vessel sign,” also known as “fruits on the branch sign,” is a combination of a distinct vessel leading directly to a nodular or mass.4 This finding can indicate one of the following: hematogenous origin near the small pulmonary vessels, a lung metastasis, or arteriovenous malformation.4,5 
Franzini D, Curry LA, Pierce-Talsma S. Osteopathic lymphatic pump techniques. J Am Osteopath Assoc. 2018;118(7):e43-44. doi:10.7556.jaoa.2018.112 [CrossRef] [PubMed]
Stawicki SP, Firstenberg MS, Lyaker MR, et al. Septic embolism in the intensive care unit. Int J Crit Illn Inj Sci. . 2013;3(1):58-63. doi: 10.4103/2229-5151.109423 [CrossRef] [PubMed]
Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest. 2005;128(1):162-166. doi: 10.1378/chest.128.1.162 [CrossRef] [PubMed]
Chiarenza A, Esposto Ultimo L, Falsaperla D, et al Chest imaging using signs, symbols, and naturalistic images: a practical guide for radiologists and non-radiologists. Insights Imaging. . 2019;10(1):114. doi: 10.1186/s13244-019-0789-4 [CrossRef] [PubMed]
Dodd JD, Souza CA, Müller NL. High-resolution MDCT of pulmonary septic embolism: evaluation of the feeding vessel sign. Am J Roentgenol. 2006;187(3):623-9. doi: 10.2214/AJR.05.0681 [CrossRef]