대한흉부영상의학회 Weekly Chest Cases

Case No : 1193 Date 2020-09-02

Courtesy of Sung Shine Shim, Woocheol Kwon / Ewha Womans University Seoul Hospital
Age/Sex 57 / M
Chief Complaintfever (5 days) / PHx: DM

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Diagnosis With Brief Discussion

Diagnosis: Septic embolism (Klebsiella Pneumonia)
Radiologic Findings: Figure 1. Chest radiography shows multifocal cavitary nodular opacities in both lungs.
Figure 2-5. Lung window of chest CT scans show peripheral wedge-shaped and cavitary nodular lesions in both lungs.
Figure 6-7. Contrast enhanced axial images reveal multiple central low-attenuated nodules with enhanced thin walls in both lungs. Right pleural effusion is also observed.
Figure 8. Abscess in rectovesical pouch extending to presacral area is noted on abdomen CT below.

The blood culture showed the presence of Klebsiella spp. in this patient.
Brief Review: The symptoms of septic embolism are not specific and involve respiratory symptoms such as dyspnea, chest pain, and cough, accompanied by bacteremia. Fever linked to bacteremia was identified in about 85% patients.
Computed tomography findings included a feeding vessel sign, nodules with or without cavities, pleural effusions, peripheral wedge-shaped opacities, patchy ground-glass opacities, air bronchograms within a nodule, consolidations, halo signs, and lung abscesses.
Studies in the recent years have found that S. aureus is the most commonly isolated vector in the septic embolism etiology of tricuspid valve infective endocarditis and pneumonia. Another study by Chou et al. identified the most commonly isolated vectors as K. pneumoniae (50%), S. aureus (35%), and P. aeruginosa (5%).
Please refer to: KSTR Imaging Conference 2013 Spring Case 1,
References: 1. Chou DW, Wu SL, Chung KM, Han SC. Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses. Clinics. 2015;70:400–7.
2. Chang Z, Gong Z, Zheng J, Ma Y, Liu Z. J Computed Tomography Features of Septic Pulmonary Embolism Caused by Klebsiella pneumoniae Liver Abscess Associated With Extrapulmonary Metastatic Infection Comput Assist Tomogr. 2016 May-Jun; 40(3):364-9.
Keywords: lung, Septic embolism, Klebsiella Pneumonia,

No. of Applicants : 61

▶ Correct Answer : 14/61, 23.0%

- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- , Korea (South) JAEHO LEE
- Mayo Clinic , Japan HIROAKI TAKAHASHI
- Holy Family Hopsital , India RAJESH GOTHI
- Other , Korea (South) KYU-CHONG LEE
- University of Tsukuba Hospital , Japan SODAI HOSHIAI
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Private sector , Greece VASILIOS TZILAS
- , India VIGNESH K
- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- , Korea (South) HYUNGYU LEE
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 13/61, 21.3%

- CH de la Cote Basque , France PAUL ARDILOUZE
- McGill University Health Center , Canada Alexandre Semionov
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
- Gifu University Hospital , Japan Yo Kaneko
- Osaka City General Hospital , Japan SHU MATSUSHITA
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- Ajou University Hospital , Korea (South) HYERIN KIM
- GEMS, Srikakulam, Andhra Pradesh , India RAMU C
- Fortis hospital , Mohali , India SHALEEN RANA
- Post graduate , India SHASHI KUMAR ANBAZHAGAN
- Yeungnam University Medical Center , Korea (South) CHOI SOOYOUNG

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1193 Date 2020-09-02

Discussion

No. of Applicants : 61