QUIZ: No. 14, 08/06/2025

ANS – Left renal subcapsular abscess with Septic Pulmonary Emboli (SPE)

Findings: Bilateral pulmonary nodules, distributed throughout all lung zones with peripheral predominance. Lesions are solid with a ground-glass halo with some lesions demonstrating central necrosis. Feeding vessel sign noted.

Septic pulmonary emboli refer to the embolization of infectious particles into the lungs via the pulmonary arterial system. The feeding vessel sign consists of a distinct vessel leading directly to a nodule or a mass.

• Best diagnostic clue: Multiple nodular opacities rapidly evolving into cavitary nodules

• Location: Basilar and peripheral

• Size: Usually small (< 3 cm diameter)

• Morphology: Nodules are more common than wedge-shaped opacities

Take home points

·   Peripheral /subpleural nodular lesions with or without necrosis and prominent feeding vessel should raise the possibility of SPE and further imaging investigation to localise the septic foci.