Septic pulmonary embolism occurs when septic material becomes detached from its origin and infiltrates into the pulmonary parenchyma causing significant clinical symptoms. It is uncommon in children and mostly related to intravascular catheterization, endocarditis, pelvic thrombophlebitis, and soft tissue infection. We report a case of a 5-year-old boy who experienced septic pulmonary embolism originating from a left shoulder abscess after traumatic injury. Magnetic resonance imaging of the shoulder revealed a multifocal subcutaneous and intramuscular abscess with septic arthritis. The initial chest radiograph showed suspicious pneumonic infiltration with nodular opacities. A percutaneous catheter was inserted to drain the shoulder abscess, and cefazedone, a first-generation cephalosporin, was administered intravenously. Two days later, a chest radiograph taken for the follow-up of the initial pneumonic infiltration with nodular opacities demonstrated aggravation of multifocal nodular lesions in bilateral lung fields, with one of the nodular cavities containing an air-fluid level. Despite the absence of significant respiratory symptoms, chest computed tomography showed multifocal necrotic nodules and cavity lesions with feeding vessel signs dominantly in the left lower lung field, which is characteristic of septic pulmonary embolism. Methicillin-susceptible Staphylococcus aureus was isolated from the shoulder abscess, whereas repeated blood and sputum cultures did not reveal any bacterial growth. With resolution of clinical symptoms as well as the finding of chest computed tomography, the patient was discharged 18 days after admission in a stable condition. Regression of the multifocal pulmonary nodular lesions was noticed on the subsequent chest imaging studies performed 45 days after the treatment.
Abscess ; Arthritis, Infectious ; Catheterization ; Catheters ; Child* ; Child, Preschool* ; Endocarditis ; Follow-Up Studies ; Humans ; Lung ; Magnetic Resonance Imaging ; Male ; Pulmonary Embolism* ; Radiography, Thoracic ; Shoulder ; Soft Tissue Infections* ; Sputum ; Staphylococcus aureus ; Thorax ; Thrombophlebitis

BACKGROUND: Hepatic hemagioendothelioma in neonatal period was rarely seen, so standard treatment does not established yet.METHODS: A retrospective analysis of patients with neonatal hepatic hemangioendothelioma at Ajou University Hospital between 2001 and 2016 was performed.RESULTS: Six patients with hepatic hemangioendothelioma in neonatal period were founded. Mean age at diagnosis was 6.1 days (range, 1-26 days). Three patients have no symptoms; diagnostic approach was prenatal ultrasonography in 2 patients, and incidental abnormal ultrasonographic findings in 1 patient, but the other 3 patients have hepatomegaly and/or congestive heart failure. Three patients were observed without treatment and the other 3 patients received medical and/or surgical treatment. Three patients of those who did not receive treatment became spontaneous regression. Of the other 3 patients, 1 patient achieved complete tumor disappearance after surgical resection, another 1 patient achieved to decrease tumor size with interferon-alpha treatment for 6 months and then had complete resolution of tumor after partial liver lobectomy, and other 1 patient who received hepatic artery embolization decreased in the size and number of lesions and then regressed gradually.CONCLUSION: Asymptomatic patients with neonatal hepatic hemangioendothelioma could have spontaneous remission, but patients with symptoms such as hepatomegaly with congestive heart failure or thrombocytopenia needed to be applied with medical and/or surgical treatment.
Diagnosis ; Heart Failure ; Hemangioendothelioma ; Hepatic Artery ; Hepatomegaly ; Humans ; Interferon-alpha ; Liver ; Remission, Spontaneous ; Retrospective Studies ; Thrombocytopenia ; Ultrasonography, Prenatal