UMEM Educational Pearls


62 year-old male presents with weakness, chills, cough, and malaise. Recently, he had four teeth extracted but felt fine immediately after the extraction. Past medical history includes diabetes and hypertension; CXR is below. What’s the diagnosis?



Answer: Septic pulmonary emboli (a.k.a. pulmonary puffballs); he was eventually diagnosed with bacterial endocarditis.

  • This history with the presence of "puffballs" on CXR, should clue the practitioner to the diagnosis of septic pulmonary emboli secondary to endocarditis
  • CT of the chest will confirm the diagnosis and possibly demonstrate cavitary lesions.
  • Blood cultures should be promptly obtained and the patient should be started on broad-spectrum antibiotics.


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