CTICasesTricuspid Endocarditis with Severe Bilateral Septic Emboli
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Imaging findings
Chest radiograph initially demonstrates extensive bilateral airspace disease in an intubated patient. Follow-up CT scan shows a highly dramatic appearance of widespread bilateral septic emboli, represented by numerous cavitary lesions in a vascular distribution, many containing air-fluid levels, with almost no normal lung parenchyma remaining. Echocardiogram confirmed tricuspid valve endocarditis, and blood cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA).
Key takeaways
Intravenous drug abuse is a major risk factor for right-sided infective endocarditis, most commonly caused by Staphylococcus aureus (including MRSA). This infection frequently leads to septic pulmonary emboli, which characteristically present on CT as multiple peripheral nodules with cavitation, feeding vessels, and air-fluid levels, occasionally leading to near-complete destruction of the lung parenchyma and severe, long-term respiratory insufficiency.
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