대한흉부영상의학회 Weekly Chest Cases

Case No : 276 Date 2003-02-08

Courtesy of Kyung-Hyun Do, M.D., Joon Beom Seo, M.D. / Asan Medical Center, Seoul, Korea
Age/Sex 45 / M
Chief ComplaintCough, sputum, fever and chill for two days. On steroid therapy due to bronchial asthma

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Diagnosis With Brief Discussion

Diagnosis: Necrotizing (Klebsiella) Pneumonia
Radiologic Findings: Initial chest radiograph shows a area of consolidation at right middle lung zone. CT scans obtained on the same day show consolidation in right upper lobe with central mottled air density. Notice that the attenuation of the consolidation is low. Follow up chest radiographs show increased extent of the consolidation with formation of air cavity in it. Notice the air-fluid level seen on the last chest radiograph.
Sputum culture revealed Klebsiella pneumoniae. The chest radiograph obtained after 3-week-antibiotic-therapy showed decreased extent of the consolidation and collapse of the cavity (not shown).
Brief Review: Pneumonia caused by Klebsiella pneumoniae, like the other gram-negative pneumonias, usually affects people with chronic debilitating illnesses or alcoholism. Classic clinical findings include high fever, cough, and toxemia. On chest radiograph, the consolidation is usually confined to one lobe with homogenous density and usually with lobar expansion (bulging fissure sign). Caviation and abscess formation is seen in 30-50% of cases. On enhanced CT scan, two intermingled parts with ill-defined margins may be seen: 1) enhancing homongenous areas which correspond to consolidative areas with intact capillary perfusion, and 2) Poorly marginated low-density areas with multiple small air cavities, suggesting hemorrhagic necrosis and abscess cavities. After treatment, enhancing homogenous areas usually recovered without sequelae, whereas the area with low density recovered with residual fibrosis.
References: 1. Armstrong P, Dee P. Infections of the lungs and pleura. In Imaging of diseases of the chest, 2nd Ed. Mosby. 1995; 158-159.
2. Moon WK et al. Complications of Klebsiella pneumonia: CT evaluation. J Comput Assist Tomogr 1995;19:176-181.
Keywords: Lung, Infection,

No. of Applicants : 19

▶ Correct Answer : 4/19, 21.1%

- Asan Medical Center, Korea Min-ju Kim
- CHU Nancy-Brabois, France Denis Regent
- Chung Li Ten-Chen Hospital,Taiwan Gui-Lin Zheng
- Hanyang University Hospital, Korea Seunghun Lee

▶ Semi-Correct Answer : 12/19, 63.2%

- Abou Kier General Hosptial, Alexandria, Egypt Shaker Abd El Fadeel Omera
- Annecy Hospital, France Gilles Genin
- Capital Armed Forces Hospital, Korea Hoil Yoon
- CHU Grenoble, France Mathieu Rodiere
- Chungju Hospital Konkuk University, Korea Chang Hee Lee
- Gwangmoung Seongae Hospital, Korea Jiyong Rhee
- Hadong Hospital, Korea Suk-Bin Seo
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Ospedale di Jesi, Italy Giancarlo Passarini
- Sarang Hospital, Incheon, Korea Jung Hee Kim
- Social Security Hospital, Ankara, Turkey Meric Tuzun
- Tokyo Kouseinenkin Hospital , Japan Noriatsu Ichiba

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 276 Date 2003-02-08

Discussion

No. of Applicants : 19