doi:10.1016/j.jemermed.2008.11.028 Clinical Communications: Adults SEPTIC PULMONARY EMBOLISM ASSOCIATED WITH RENAL ABSCESS: A CASE REPORT Müge Günalp, MD, Serdar Gürler, MD, Onur Polat, MD, and Arda Demirkan, MD, PHD, Department of Emergency Medicine, School of Medicine, Ankara University, Ankara, Turkey Reprint Address: Müge Günalp, MD, Department of Emergency Medicine, School of Medicine, Ankara University, Ibn-i Sina Hospital, Samanpazari, Ankara, Turkey e Abstract—Background: Septic pulmonary embolism (SPE) is a rare condition that is difficult to diagnose. Ob- jectives: To describe the clinical course and diagnosis of a patient with SPE. Case report: We report on a case of SPE diagnosed in the emergency department and review the current literature. Conclusion: The diagnosis of SPE can be made using computed tomography scan. Early diagnosis and appropriate antibiotic therapy are important factors for the control of the infection. © 2012 Elsevier Inc. e Keywords—septic pulmonary embolism; pulmonary computed tomography; renal abscess INTRODUCTION Septic pulmonary embolism (SPE) is a type of non- thrombotic pulmonary embolism that originates from septic phlebitis, which consists of purulent material ad- mixed with fibrin thrombus at the primary site of infec- tion. It is an uncommon disorder (1). SPE has been reported to be associated with a septicemia due to bac- terial endocarditis, infected venous catheters, and odon- togenic infections (2–5). Recently, the increased long- term use of indwelling catheters inserted for diagnostic or therapeutic purposes in immunocompromised patients has been reported as a common cause (6). Other initial foci of infection reported in the literature are septic pelvic thrombophlebitis, peritonsillar abscess, cellulitis, urinary tract infection, osteomyelitis, and intravenous drug abuse (7). Clinical and radiological features at presentation are usually non-specific, and the diagnosis of this disorder is frequently delayed. We report a case of pulmonary septic emboli due to renal abscess, an uncommon predisposing condition. Pulmonary computed tomography (CT) scan revealed multiple nodular shadows with features charac- teristic of SPE in this patient. CASE REPORT A 59-year-old diabetic woman was admitted to our hos- pital with symptoms of fever, right-sided costovertebral angle pain, and dysuria for 2 days. She had been treated with extracorporeal shock wave lithotripsy 2 years prior. On physical examination, the patient had an elevated temperature of 39°C, a blood pressure of 120/82 mm Hg, a pulse of 120 beats/min, and a respiratory rate of 18 breaths/min. The patient was not in acute distress, but she was mildly ill-appearing. The oropharynx was clear, with slightly dry mucous membranes. The lungs were clear to auscultation, and the heart rate was regular but tachycardic, without murmurs. The abdominal examina- tion revealed moderate tenderness at the right costover- tebral angle. There was no rebound tenderness, and the genital examination was noted to be normal. The remain- der of the physical examination was unremarkable. RECEIVED: 31 July 2008; FINAL SUBMISSION RECEIVED: 19 October 2008; ACCEPTED: 18 November 2008 The Journal of Emergency Medicine, Vol. 42, No. 3, pp. e51– e53, 2012 Copyright © 2012 Elsevier Inc. Printed in the USA. All rights reserved 0736-4679/$–see front matter e51