Online First
Clinical Images  |   September 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: kemnicty@msu.edu
     
Article Information
Pulmonary Disorders
Clinical Images   |   September 2020
Septic Pulmonary Emboli With Feeding Vessel Sign
The Journal of the American Osteopathic Association Published Online First on September 23, 2020. doi:https://doi.org/10.7556/jaoa.2020.130
The Journal of the American Osteopathic Association Published Online First on September 23, 2020. doi:https://doi.org/10.7556/jaoa.2020.130
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. 

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