\\bosley PC, et al. An angiographic severity index for pulmonary embolism. Circulation 1973; 47(suppl2):101-8 6 Dieclc .JA, Ferguson JJ. Indications for thrombolytic therapy in acute pulmonary embolism. Texas Heart lost J 1989; 16:19-26 7 Olinger GN, Hussey CV, Olive JA, Malik MI. Cardiopulmonary bypass for patients with previously documented heparin-induced platelet aggregation. J Thorac Cardiovasc Surg 1984;
87:673-77 8 Cole CW, Bormanis J. Ancrod: a practical alternative to heparin. J Vase Surg 1988; 8:59-63 9 Kappa JR, Hom MK III, Fisher CA, Cottrell ED, Ellison N, Addonizio VP Jr. Efficacy of iloprost (ZK36374) versus aspirin in preventing heparin-induced platelet activation during cardiac operations. J Thorac Cardiovasc Surg 1987; 94:405-13 10 O'Keefe JH, Lapeyre AC, Holmes DR, Gibbons RJ. Usefulness ofearly radionuclide angiography for identifying low risk patients for late restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol1988; 61:51-4
Septic Pulmonary Embolism Complicating A Central Venous Catheter* joseph S. Cllf"lM, M.D.; 'I1wmas A Caputo, M.D.; Sheila D . .l.:>cMa, M.D.; and Henry W Murray, M.D.
Bacteremia is a recognized complication in patients with indwelling central venous catheters. More recently pulmonary embolism in such patients has also been described. Despite abuudant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients. This case illustrates such a complication. (Chut 1990; 98:1526)
S
eptic pulmonary embolism associated with an indwelling central venous catheter has not been previously described in an adult• (to our knowledge). The following case report illustrates such a complication. CASE REPORT Four months prior to hospital admission, an 18-yeaNJ!d woman was found to have a well-localized ovarian endodermal sinus tumor. A chest roentgenogram was normal. Over the next three months,
she received chemotherapy through a Broviac catheter inserted into the left subclavian vein. Two weeks before admission, cough, bilateral pleuritic chest pain, and low-grade fever developed. These symptoms recurred episodically. Computed tomography (CI') of the abdomen four days prior to admission revealed multiple pulmonary nodules at both lung bases (Fig 1A), and metastatic disease was suspected. The patient was admitted for percutaneous needle biopsy of the lung. On admission, she was febrile to 39.2"C but did not appear ill. Results of physical examination were unremarkable. The white blood cell count was 7,300/cu mm. A chest roentgenogram showed two 1- to 2-cm nodular lesions in the right upper lobe and one in the left lower lobe. Repeat CT was not performed. Because of persistent fever, lung biopsy was postponed, and therapy with vancomycin and gentamicin was begun on admission. Within 48 hours, the patient was afebrile. Staphylococcus aureus grew from three blood cultures drawn peripherally and two drawn through the central line, and gentamicin therapy was discontinued. An echocardiogram was normal. The Broviac catheter was removed on *From the Division oflnfectious Diseases (Drs. Cervia and Murra~ and the Departments of Obstetrics and Gynecology (Dr. Caputo and Radiology (Dr. Davis), The New York Hospital-Cornell Medi Center, New York, NY.
1521
FIGURE 1A (upper). Lung windows of an initial preadmission computed tomographic (Clj scan of the abdomen demonstrate two nodular pulmonary lesions at the right lung base (arrows). 8, (lower). CT scan of the chest on hospital day 16 reveals, in comparison to Figure 1A, resolution of the lesion situated anteriorly at the right lung base. The lateral pleural-based lesion is decreased in size. New lesions are now present bilaterally (arrows). hospital day 6 and subsequent blood cultures were negative. The remainder of the patient's three-week course of vancomycin treatment was uneventful. A chest CT scan on hospital day 16 (Fig 18) demonstrated partial to complete resolution of several lesions at the lung bases, as well as new lesions that presumably had developed prior to catheter removal. A follow-up chest CT scan obtained four weeks after hospital discharge showed a decrease in the size of all parenchymal densities. DISCUSSION
Bacteremia is a well-recognized complication in patients with indwelling central venous catheters. 1 However, with the exception of a single case reported in the pediatric literature,• abundant clinical experience indicates that septic pulmonary embolism in such patients essentially does not occur.• While unexplained, the latter observation is not surprising since it is unusual for central catheters to be associated with recognized pulmonary emboli of any type.• Nevertheless, the experience with our patient in whom multiple pulmonary nodules were initially believed to represent metastases illustrates what appears to be a clear example of septic pulmonary embolism complicating an infected indwelling venous catheter. REFERENCES
1 Leiby JM, Purcell H, DeMaria JJ, Kraut EH, Sagone AL, Metz EN. Pulmonary embolism as a result of Hickman catheter-related thrombosis. Am J Med 1989; 86:228-31 2 Haddad W, ldowu J, Georgeson K, Bailey L, Doroshow R, Pickham N. Septic atrial thrombosis: a potentially lethal complication of Broviac catheters in infants. AJDC 1986; 140:778-80 Septic Pulmonary Embolism (Cervia et al)
87:673-77 8 Cole CW, Bormanis J. Ancrod: a practical alternative to heparin. J Vase Surg 1988; 8:59-63 9 Kappa JR, Hom MK III, Fisher CA, Cottrell ED, Ellison N, Addonizio VP Jr. Efficacy of iloprost (ZK36374) versus aspirin in preventing heparin-induced platelet activation during cardiac operations. J Thorac Cardiovasc Surg 1987; 94:405-13 10 O'Keefe JH, Lapeyre AC, Holmes DR, Gibbons RJ. Usefulness ofearly radionuclide angiography for identifying low risk patients for late restenosis after percutaneous transluminal coronary angioplasty. Am J Cardiol1988; 61:51-4
Septic Pulmonary Embolism Complicating A Central Venous Catheter* joseph S. Cllf"lM, M.D.; 'I1wmas A Caputo, M.D.; Sheila D . .l.:>cMa, M.D.; and Henry W Murray, M.D.
Bacteremia is a recognized complication in patients with indwelling central venous catheters. More recently pulmonary embolism in such patients has also been described. Despite abuudant clinical experience with these devices, to our knowledge, septic pulmonary embolism has not been reported in adult patients. This case illustrates such a complication. (Chut 1990; 98:1526)
S
eptic pulmonary embolism associated with an indwelling central venous catheter has not been previously described in an adult• (to our knowledge). The following case report illustrates such a complication. CASE REPORT Four months prior to hospital admission, an 18-yeaNJ!d woman was found to have a well-localized ovarian endodermal sinus tumor. A chest roentgenogram was normal. Over the next three months,
she received chemotherapy through a Broviac catheter inserted into the left subclavian vein. Two weeks before admission, cough, bilateral pleuritic chest pain, and low-grade fever developed. These symptoms recurred episodically. Computed tomography (CI') of the abdomen four days prior to admission revealed multiple pulmonary nodules at both lung bases (Fig 1A), and metastatic disease was suspected. The patient was admitted for percutaneous needle biopsy of the lung. On admission, she was febrile to 39.2"C but did not appear ill. Results of physical examination were unremarkable. The white blood cell count was 7,300/cu mm. A chest roentgenogram showed two 1- to 2-cm nodular lesions in the right upper lobe and one in the left lower lobe. Repeat CT was not performed. Because of persistent fever, lung biopsy was postponed, and therapy with vancomycin and gentamicin was begun on admission. Within 48 hours, the patient was afebrile. Staphylococcus aureus grew from three blood cultures drawn peripherally and two drawn through the central line, and gentamicin therapy was discontinued. An echocardiogram was normal. The Broviac catheter was removed on *From the Division oflnfectious Diseases (Drs. Cervia and Murra~ and the Departments of Obstetrics and Gynecology (Dr. Caputo and Radiology (Dr. Davis), The New York Hospital-Cornell Medi Center, New York, NY.
1521
FIGURE 1A (upper). Lung windows of an initial preadmission computed tomographic (Clj scan of the abdomen demonstrate two nodular pulmonary lesions at the right lung base (arrows). 8, (lower). CT scan of the chest on hospital day 16 reveals, in comparison to Figure 1A, resolution of the lesion situated anteriorly at the right lung base. The lateral pleural-based lesion is decreased in size. New lesions are now present bilaterally (arrows). hospital day 6 and subsequent blood cultures were negative. The remainder of the patient's three-week course of vancomycin treatment was uneventful. A chest CT scan on hospital day 16 (Fig 18) demonstrated partial to complete resolution of several lesions at the lung bases, as well as new lesions that presumably had developed prior to catheter removal. A follow-up chest CT scan obtained four weeks after hospital discharge showed a decrease in the size of all parenchymal densities. DISCUSSION
Bacteremia is a well-recognized complication in patients with indwelling central venous catheters. 1 However, with the exception of a single case reported in the pediatric literature,• abundant clinical experience indicates that septic pulmonary embolism in such patients essentially does not occur.• While unexplained, the latter observation is not surprising since it is unusual for central catheters to be associated with recognized pulmonary emboli of any type.• Nevertheless, the experience with our patient in whom multiple pulmonary nodules were initially believed to represent metastases illustrates what appears to be a clear example of septic pulmonary embolism complicating an infected indwelling venous catheter. REFERENCES
1 Leiby JM, Purcell H, DeMaria JJ, Kraut EH, Sagone AL, Metz EN. Pulmonary embolism as a result of Hickman catheter-related thrombosis. Am J Med 1989; 86:228-31 2 Haddad W, ldowu J, Georgeson K, Bailey L, Doroshow R, Pickham N. Septic atrial thrombosis: a potentially lethal complication of Broviac catheters in infants. AJDC 1986; 140:778-80 Septic Pulmonary Embolism (Cervia et al)
