Osteomyelite sekonder septik emboli olgusu

Nefes darlığı, sol bacakta şişlik ve sıcaklık artışı şikayetleri ile acil servise başvuran 58 yaşında bir bayan hasta, akciğer grafisinde bilateral periferik yaygın infiltrasyonlar ve arteryel kan gazında ciddi hipoksemisi saptanması üzerine sepsis, ARDS, pulmoner emboli ve vaskülit öntanıları ile kliniğimize yatırıldı. Toraks BT'sinde akciğer parankiminde periferik yerleşimli kavitasyon içeren nodüller gözlendi. Kemik sintigrafisinde osteomyelit saptandı. Bu bulgularla osteomyelite sekonder septik emboli tanısı kondu. Ampirik antibiyotik, noninvazif mekanik ventilasyon ve destek tedavisi ile klinik ve radyografik bulgularında iyileşme sağlandı. Akciğer grafisinde infiltrasyonların bilateral ve periferik olması; toraks BT'de subplevral yerleşimli kaviter nodüllerin görülmesi, başka bir odakta infeksiyon bulgularının olması pnömoninin hematojen kaynaklı olabileceğinin anlamlı ipuçlarıdır.

A case of septic emboli secondary to osteomyelitis

A 58 year-old woman was admitted to our emergency department with dyspnea, swelling and increased temperature of left leg. Since bilateral peripheral disseminated infiltrates on chest X-ray and severe hypoxemia in arterial blood gas were found, she was hospitalized with initial diagnosis of sepsis, Adult Respiratory Distress Syndrome, pulmonary embolism and vasculitis. Computed tomography revealed peripheral cavitary nodules in pulmonary paranchyme. Osteomyelitis was established in bone scan. Based on these findings the diagnosis was septic embolism secondary to osteomyelitis. Clinical and radiographic parameters were improved by empirical antibiotic therapy, noninvasive mechanical ventilation and other supportive care. Bilateral and peripheral infiltrates on chest x-ray; sub-pleural cavitary nodules on computed tomography and the presence of an extrapulmonary infection focus are significant clues that pneumonia may occur via hematogenous spread.

Kaynakça

1. Rossi SE, Goodman PC, Franquet T. Nonthrombotic pulmonary emboli. AJR Am J Roentgenol 2000;174: 1499-1508.

2. King MB, Harmon KR. Unusual forms of pulmonary embolism. Clin Chest Med 1994;15:561-580.

3. Griffith GL, Maull KI, Sachatello CR. Septic pulmonary embolization. Surg Gynecol Obst 1977;144:105-8.

4. MacMillan JC, Milstein SH, Samson PC. Clinical spectrum of septic pulmonary embolism and infarction. J Thorac Cardiovasc Surg 1978;75:670-9.

5. Huang RM,NaidichDP, Lubat E, et al. Septic pulmonary emboli: CT radiographic correlation. AJR Am J Roentgenol 1989;153:41-5.

6. Rachel JC, Rendell WAs, Gregory LA, et al. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest 2005; 128:162 -6.

7. Kuhlman JE, Fishman EK, Teigen C. Pulmonary septic emboli: diagnosis with CT. Radiology 1990;174: 211-3.

8. Pulmonary thromboembolism. In: Murray JF, Nadel JA eds.Textbook of respiratory medicine. 3rd Edition. WB Saunders Company, 2000:1503-1531.

9. Jaffe RB, Koschmann EB. Septic pulmonary emboli. Radiology 1970;96:527-32.

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