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High-Resolution MDCT of Pulmonary Septic Embolism: Evaluation of the Feeding Vessel Sign

Jonathan D. Dodd1,2, Carolina A. Souza1,2 and Nestor L. Müller1,2

1 Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada.
2 Department of Radiology, St. Vincents University Hospital, 855 W 12th Ave., Vancouver, BC, Canada V6K 1R4.


Figure 1
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  		Fig. 1A —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Transverse 1.25-mm contiguous MDCT images through left upper lobe show irregular nodule (curved arrow) with distinct central vessel (straight arrow) leading into its center.

 

Figure 2
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  		Fig. 1B —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Transverse 1.25-mm contiguous MDCT images through left upper lobe show irregular nodule (curved arrow) with distinct central vessel (straight arrow) leading into its center.

 

Figure 3
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  		Fig. 1C —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Transverse 1.25-mm contiguous MDCT images through left upper lobe show irregular nodule (curved arrow) with distinct central vessel (straight arrow) leading into its center.

 

Figure 4
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  		Fig. 1D —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Contiguous coronal 1.25-mm multiplanar reconstructions show vessel (arrow) passing around nodule, which was not appreciable on transverse images.

 

Figure 5
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  		Fig. 1E —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Contiguous coronal 1.25-mm multiplanar reconstructions show vessel (arrow) passing around nodule, which was not appreciable on transverse images.

 

Figure 6
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  		Fig. 1F —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Contiguous coronal 1.25-mm multiplanar reconstructions show vessel (arrow) passing around nodule, which was not appreciable on transverse images.

 

Figure 7
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  		Fig. 1G —49-year-old male IV drug user with epidural abscess and positive culture results for Staphylococcus aureus. Blood cultures also were positive for Staphylococcus aureus. Contiguous coronal 1.25-mm multiplanar reconstructions show vessel (arrow) passing around nodule, which was not appreciable on transverse images.

 

Figure 8
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  		Fig. 2A —25-year-old female IV drug user admitted to hospital with shortness of breath. Blood cultures were positive for Staphylococcus aureus. Transverse 1.25-mm MDCT image through left lower lobe shows cavitating wedge-shaped opacity with distinct central vessel (arrow) leading into it.

 

Figure 9
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  		Fig. 2B —25-year-old female IV drug user admitted to hospital with shortness of breath. Blood cultures were positive for Staphylococcus aureus. Contiguous coronal oblique 1.25-mm multiplanar reconstruction does not adequately depict precise relation of vessel relative to cavitating opacity (arrow).

 

Figure 10
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  		Fig. 2C —25-year-old female IV drug user admitted to hospital with shortness of breath. Blood cultures were positive for Staphylococcus aureus. Oblique IV contrast-enhanced 20-mm maximum-intensity-projection (MIP) image shows vessels (arrows) passing around sides of cavitating nodule that were not identified on transverse images. MIP images confirmed vessel to be venous. Second, smaller more caudal nodule has several vessels (arrowheads) passing around it.

 

Figure 11
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  		Fig. 3A —Same patient as in Figures 2A, 2B, and 2C. Transverse 1.25-mm MDCT image through right lower lobe shows cavitating nodule (curved arrow) with distinct central vessel (straight arrow) leading into it.

 

Figure 12
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  		Fig. 3B —Same patient as in Figures 2A, 2B, and 2C. Coronal oblique1.25-mm multiplanar reconstruction confirms presence of distinct central vessel (arrow) leading into opacity.

 

Figure 13
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  		Fig. 3C —Same patient as in Figures 2A, 2B, and 2C. Selected transverse 1.25-mm MDCT images after IV administration of contrast bolus show vessel (arrow) filled with contrast material coursing superiorly and medially and inserting into left atrium, consistent with pulmonary vein. Curved arrow indicates nodule.

 

Figure 14
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  		Fig. 3D —Same patient as in Figures 2A, 2B, and 2C. Selected transverse 1.25-mm MDCT images after IV administration of contrast bolus show vessel (arrow) filled with contrast material coursing superiorly and medially and inserting into left atrium, consistent with pulmonary vein. Curved arrow indicates nodule.

 

Figure 15
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  		Fig. 3E —Same patient as in Figures 2A, 2B, and 2C. Selected transverse 1.25-mm MDCT images after IV administration of contrast bolus show vessel (arrow) filled with contrast material coursing superiorly and medially and inserting into left atrium, consistent with pulmonary vein. Curved arrow indicates nodule.

 

Figure 16
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  		Fig. 3F —Same patient as in Figures 2A, 2B, and 2C. Selected transverse 1.25-mm MDCT images after IV administration of contrast bolus show vessel (arrow) filled with contrast material coursing superiorly and medially and inserting into left atrium, consistent with pulmonary vein. Curved arrow indicates nodule.

 

Figure 17
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  		Fig. 3G —Same patient as in Figures 2A, 2B, and 2C. Coronal oblique 20-mm maximum-intensity-projection images confirm vessel (arrow) as venous.

 

Figure 18
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  		Fig. 3H —Same patient as in Figures 2A, 2B, and 2C. Coronal oblique 20-mm maximum-intensity-projection images confirm vessel (arrow) as venous.

 

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