CTICasesInfective Aortic Wall Vegetations in Streptococcal Sepsis
Imaging findings
In a patient with severe necrotizing Streptococcus pneumoniae pneumonia and bacteremia, CT angiogram performed to evaluate for pulmonary embolism showed emphysema with necrotizing consolidation and cavities, plus new small nodular and irregular soft tissue foci along the aortic lumen in the chest and abdomen that were not present on a CT scan ten days earlier and did not correspond to sites of atherosclerotic plaque.
Key takeaways
The soft tissue foci were interpreted as probable infective vegetations or aortitis from hematogenous seeding of the aortic wall during severe bacteremia, rather than atherosclerotic plaque or bland thrombus, given their rapid interval appearance over about a week in a septic patient without a corresponding cardiac valve source. This illustrates that the aortic wall itself can become secondarily infected and mimic atherosclerotic plaque during severe bloodstream infection.
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