Page 23 - Virtual Vascular Vol 8

Pulmonary Embolism

Septic emboli with mycotic pseudoaneurysms
A patient was admitted with

extensive deep vein thrombosis

involving the left lower limb. He
also presented with severe

shortness of breath and chest
pain associated with sinus

tachycardia

Figure 1

This is the CT scan finding: Serial
scan from Figure 1 to Figure 3

show massive pulmonary

embolism involving the right
pulmonary artery (arrow)

Figure 1 Figure 2

Apart from systemic

A 50-year-old man with ischaemic cardiomyopathy with left anticoagulation, in
ventricular assist device implanted presented with persistent sepsis haemodynamically unstable

due to sternal wound infection and pericardial abscess. Wound swab Figure 2 patients with massive pulmonary

and blood culture grew Methicillin sensitive Staphylococcus aureus. embolism, active intervention
Despite drainage and antibiotic treatment, sepsis persisted. A CT scan with open pulmonary

was performed. Figure 1 showed splenic abscesses (single arrow) as embolectomy, systemic
well as a splenic artery pseudoaneurysm (double arrow) secondary to thrombolysis or catheter-

septic emboli. Figure 2 showed a superior mesenteric artery directed thrombolysis/

pseudoaneurysm (arrow) secondary to septic emboli. thrombectomy should also be
considered

Multiple aneurysms or pseudoaneurysm, particularly in the

mesenteric circulation, should raise suspicions of a septic origin.
Intracranial aneurysm is also an associated condition.

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Figure 3