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Weekly Chest CasesArchive of Old Cases

Case No : 734 Date 2011-11-22

  • Courtesy of Soo Yun Ham MD. / Korea University Anam Hospital
  • Age/Sex 56 / M
  • Chief ComplaintFever (for 1 week), intermittent right chest pain. Chronic alcoholics, Diabetes
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6

Figure 1

Diagnosis With Brief Discussion

Diagnosis
Klebsiella Pneumonia with septic embolism.
Radiologic Findings
Chest radiography revealed multifocal patchy nodular opacity and consolidative lesion, LUL dominant.
Contrast enhanced axial chest CT scan showed multiple nodular consolidative lesions with central low attenuations and subpleurally distributed, both lungs,
Brief Review
Klebsiella pneumoniae is the second most common cause (behind Escherichia coli) of community- and hospital-acquired Gram-negative bloodstream infection. K. pneumoniae bloodstream infections usually arise as a complication of focal urinary, gastrointestinal, or respiratory tract infections, although occasionally they can arise without a definable source (1, 2). The importance of K. pneumoniae as an invasive pathogen seems to be increasing. In the past 2 decades, highly invasive hypermucoid strains associated with liver abscesses and septic metastasis have been described and have emerged as a leading cause of pyogenic liver abscesses in several Asian countries (1). According to Okada F, et al (3), the combination of consolidation and ground-glass attenuation (n = 178, 89.9%) was seen most frequently, followed by consolidation and intralobular reticular opacity (n = 161, 81.3%). Some ground-glass attenuation was also detected in areas near bronchial wall thickening.
References
1) Meatherall BL, Gregson D, Ross T, Pitout JD, Laupland KB. Incidence, risk factors, and outcomes of Klebsiella pneumonia bacteremia. Am J Med. 2009;122(9):866-73
2) Okada F, Ando Y, Honda K, et al. Acute Klebsiella pneumoniae pneumonia alone and with concurrent infection: comparison of clinical and thin-section CT findings. Br J Radiol. 83(994):854-60.
3) Okada F, Ando Y, Honda K, et al. Clinical and pulmonary thin-section CT findings in acute Klebsiella pneumonia pneumonia. Eur Radiol 2009;19(4):809-15.
Keywords
lung, infection, bacterial,

No. of Applicants : 96

▶ Correct Answer : 21/96,  21.9%
  • - Samsung medical Center , Korea (South) Ah Yeong Kim
  • - Okayama University , Japan Akihiro Tada
  • - Fukuyama daiichi Hospital , Japan Mototsugu Saeki
  • - University of British Columbia , Canada Amr Ajlan
  • - Korea university , Korea (South) SUMIN HA
  • - Seoul National University Hospital , Korea (South) Hyungjin Kim
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - NIRMAN HITECH DIAGNOSTIC CENTRE , India PADMA KANNAN
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - stanley medical college , India arivudai nambi
  • - Korea University Ansan hosipital , Korea (South) Doran Hong
  • - Korea university , Korea (South) Kun Woo Kang
  • - ministry of health , United Arab Emirates jesia mansoor
  • - NDMVP Nashik , India Imran Jindani
  • - CHA Bundang hospital , Korea (South) Hyerin Kim
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - Sunchun university hospital, Bucheon , Korea (South) So Young Bae
  • - Montreal , Canada D J
  • - Seoul St Mary Hospital , Korea (South) Chae Lim
  • - Okayama university , Japan Mayu Uka
▶ Correct Answer as Differential Diagnosis : 29/96,  30.2%
  • - A.P.Chest hospital ,hyderabad , India bhaskar kakarla
  • - China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Dong-A University Hospital , Korea (South) Ji-yeon Han
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - CHRU lille , France manuel toledano
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - Onomichi municipal hospital , Japan Ryotaro Kishi
  • - KOREA UNIVERSITY ANSAN HOSPITAL , Korea (South) Inyoung Choi
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - radiologist, aditya imaging centre , India vivek patel
  • - IRSA , France jean-luc BIGOT
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Chonnam National University , Korea (South) se hee Jung
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - snuh , Korea (South) Choo jiyung
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Kohka Public Hospital , Japan Akitoshi Inoue
  • - Kobe City Medical Center General Hospital , Japan Junko Ochi
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
  • - DongA University hospital , Korea (South) Jiyoung Kang
  • - Chonnam National University Hwasoon Hospital , Korea (South) You Ri Choi
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Mallinckrodt Institute of Radiology , United States Naganathan Mani
  • - chp st martin , France Mariotte benoit
  • - Gwangju 21st century hospital , Korea (South) Hyungwoo Oh
  • - NASA SCANS , India RAKESH BHATIA
▶ Semi-Correct Answer : 2/96,  2.1%
  • - Hopital Louis Pradel LYON , France matthieu ROUSSET
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
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