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RADIOLOGY: CHEST: Case# 33955: SEPTIC EMBOLI. 72 year old man with diagnosis of ulcerative colitis admitted with fever and probable sepsis. Chest x-ray showed bilateral cavitary lesions. 1. Multiple cavitary pulmonary lesions most consistent radiographically with septic emboli associated with more confluent consolidation of the right lower lobe consistent with pneumonia. Differential diagnosis also includes Wagners granulomatous as well as metastatic disease but these are felt to be much less likely. 2. Small bilateral pleural effusions probably inflammatory. 3. Acute thrombus in both main pulmonary arteries greater on the left. Given the infected appearance of the pulmonary nodules, the possibility is raised that the thrombus seen is infected since cavitation in bland pulmonary emboli is unusual. 4. Fatty liver without focal lesions. 5. Cholelithiasis without radiographic evidence of acute cholecystitis.

Peter Anderson
Chest, radiology