Fig. 11
From: Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin
Two different cases of septic thrombophlebitis (STP) after intravenous drug injection. A-B) in a 57-year-old HIV-seropositive male patient, contrast-enhanced CT images showed strongly enhancing “tram-track” fistula (arrowheads) along the puncture track, and similar mural enhancement of the thrombosed ipsilateral femoral vein (arrows). Pus culture from draining orifice tested positive for Methycillin-sensitive Staphylococcus aureus. C-F) in a 34-year-old man with high fever, right thigh swelling, bloody and purulent drainage at the groin. The non-opacified right common, external iliac and femoral veins (arrows in C, D) showed prominent wall enhancement and some endoluminal gas bubbles. A “tram-track” fistula connected to the depressed injection site (arrowhead in C). Additionally, body CT showed pleural effusions, lung base consolidation (+), mediastinal adenopathies and subpleural lesions with central cavitations consistent with septic emboli (thick arrows in E, F). Blood and groin pus cultures revealed polymicrobial infection, which required two months of antibiotics and intensive care hospitalisation [Adapted with permission from ref. no. [39]]