Early Сontrast-Enhanced Multispiral Computed Tomographic Diagnosis of Septic Pulmonary Embolism and a Case of Successful Surgical Treatment
https://doi.org/10.20862/0042-4676-2019-100-5-304-308
Abstract
The review presents a rare clinical case of right-sided infective endocarditis (IE), a variant of early diagnosis using contrast-enhanced multispiral computed tomography (CE-MSCT), and successful surgical treatment for septic pulmonary embolism and right-sided IE. The clinical manifestation of the disease lasted about 3 weeks. The diagnosis was established according to the results of an emergency complex CE-MSCT study. At 4 hours after the patient went to the clinic, a combined operation (removal of part of the venous port and thrombectomy from the left pulmonary branch) was successfully performed. There was a complete coincidence of CE-MSCT study data and intraoperative results; staphylococcal septic focus was confirmed in a laboratory. The total length of stay in hospital was 9 days; that of full performance restoration was 3 weeks. The presented case has proven that the CE-MSCT may be the only sufficient technique for detecting septic pulmonary embolism and deciding in favor of surgical treatment, eliminating the need for a different kind of instrumental diagnosis, which significantly reduces the time of diagnosis.
Keywords
About the Authors
M. B. SukhovaRussian Federation
Мarina B. Sukhova, Cand. Med. Sc., Head of X-ray Diagnostic Department
ul. Vaneeva, 209, Nizhny Novgorod, 603950, Russian Federation
А. P. Medvedev
Russian Federation
Аleksandr P. Medvedev, Dr. Med. Sc., Professor, Chief of Chair of Hospital Surgery
pl. Minina i Pozharskogo, 10/1, Nizhny Novgorod, 603005, Russian Federation
References
1. Vatutin N.Т., Sklyannaya Е.V., Eshchenko Е.V., Degtyareva А.E., Kravchenko А.V., Kartamysheva Е.V. et al. Pulmonary embolism. Review of the European Society of Cardiology guidelines for diagnosis and treatment (2014). Practical Angiology. 2015; 1 (68): 5–18 (in Russ.).
2. Jorens P.G., Van Marck E., Snoeckx A., Parizel P.M. Nonthrombotic pulmonary embolism. Eur. Respir. J. 2009; 34 (2): 452–74. DOI: 10.1183/09031936.00141708
3. Suhova M.B., Medvedev A.P., Abolenskaya M.V. MSCT-assessment of the combined treatment of acute PE – thrombolytic therapy with the subsequent trombectomy. Modern Problems of Science and Education. 2019; 4: 45 (in Russ.).
4. Brenes J.A., Goswami U., Williams D.N. The association of septic thrombophlebitis with septic pulmonary embolism in adults. Open Respir. Med. J. 2012; 6: 14–9. DOI: 10.2174/1874306401206010014
5. Celebi Sözener Z., Kaya A., Atasoy C., Kılıckap M., Numanoglu N., Savas I. Septic pulmonary embolism: three case reports. Monaldi Arch. Chest Dis. 2008; 69 (2): 75–7. DOI: 10.4081/monaldi.2008.400
6. Thornhill M.H., Gibson T.B., Cutler E., Dayer M.J., Chu V.H., Lockhart P.B. et al. Antibiotic prophylaxis and incidence of endocarditis before and after the 2007 AHA recommendations. J. Am. Coll. Cardiol. 2018; 72 (20): 2443–54. DOI: 10.1016/j.jacc.2018.08.2178
7. Sukhova M.B., Shumakov I.V., Zakrevsky A.V. Computed tomography in the management of patients with tromboembolia branches of the pulmonary artery. The Journal of Scientific Articles “Health & Millenium Education”. 2017; 19 (12): 285–90. DOI: 10.26787/nydha-2226-7425-2017-19-12-285-290
8. Goswami U., Brenes J.A., Punjabi G.V., LeClaire M.M., Williams D.N. Associations and outcomes of septic pulmonary embolism. Open Respir. Med. J. 2014; 8: 28–33. DOI: 10.2174/1874306401408010028
9. Kozina M.B. Ethiopathogenetic grounding of indications for comprehensive MSCT examination of patients having indications of thromboembolism of the pulmonary artery. Medical Almanac. 2017; 3 (48): 161–4 (in Russ.). DOI: 10.21145/2499-9954-2017-3-161-164
10. Gould F.K., Denning D.W., Elliott T.S.J., Foweraker J., Perry J.D., Prendergast B.D. et al. Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J. Antimicrob. Chemother. 2012; 67 (2): 269–89. DOI: 10.1093/jac/dkr450
11. Pasternak J.J., Williamson E.E. Clinical pharmacology, uses, and adverse reactions of iodinated contrast agents: aprimer for the non-radiologist. Mayo Clin. Proc. 2012; 87 (4): 390–402. DOI: 10.1016/j.mayocp.2012.01.012
12. Achenbach S., Paul J., Laurent F., Becker H., Rengo M., Caudron J. et al. Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial. Eur. Radiol. 2017; 27 (2): 821–30. DOI: 10.1007/s00330-016-4437-9
Review
For citations:
Sukhova M.B., Medvedev А.P. Early Сontrast-Enhanced Multispiral Computed Tomographic Diagnosis of Septic Pulmonary Embolism and a Case of Successful Surgical Treatment. Journal of radiology and nuclear medicine. 2019;100(5):304-308. (In Russ.) https://doi.org/10.20862/0042-4676-2019-100-5-304-308