Xiaobin Zhang1, Qian Yang1, Bo Gao2, Jialu Wang1, Lei Tian1, Jia Hua3, Changqing Zhu1, Xiaoye Lu4. 1. Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 2. Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Critical Care Medicine, Pu Dong Hospital, Shanghai Fudan University, Shanghai, China. 3. Department of Radiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. 4. Department of Emergency Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. luxiaoye_rj@163.com.
Abstract
BACKGROUND: Septic pulmonary embolism (SPE) is attracting more attention as a special pulmonary sign in severe infection. We aimed to describe the clinical and imaging features of Klebsiella pneumoniae (K. pneumonia)-associated SPE in the emergency department. METHODS: Records of patients with primarily extrapulmonary infection of K. pneumoniae who were admitted to the emergency department between 2014 and 2019 were retrieved. The identifications of K. pneumoniaeassociated SPE were mainly dependent on the clinical manifestations, typical imaging findings, and presence of a primary source of K. pneumoniae infection. RESULTS: A total of 33 cases were identified as SPE with extrapulmonary K. pneumoniae infection. The main clinical manifestations were a febrile/fragile state (100%), respiratory symptoms (18.2%), and digestive symptoms (33.3%). Eight patients (24.2%) developed septic shock, 2 (6.0%) experienced respiratory failure, and 2 (6.0%) complicated endophthalmitis. The major source of infection was liver abscess (n=26, 78.8%), followed by septicemia (n=8, 24.2%), intestinal infection (n=3, 9.1%), and ascites (n=1, 3.0%). The computed tomography (CT) features included the following: peripheral wedge-shaped opacity (n=12, 36.4%), a feeding vessel sign (n=3, 9.1%), multiple nodular lesions (n=5, 15.2%), multifocal lung ill-infiltrations (n=15, 45.5%), patchy ground-glass opacities (n=6, 18.2%), focal consolidations (n=9, 27.3%), lung abscesses (n=4, 12.1%), and pleural effusion (n=21, 63.6%). Re-examination of lung HRCT conducted in 7 patients demonstrated imaging improvement after treatment. CONCLUSIONS: K. pneumonia-SPE presented special clinical and imaging characteristics, which bear similarities to the signs of pneumonia, but was potentially catastrophic. Identifying SPE in septic conditions is crucial to improving clinical outcomes.
BACKGROUND:Septic pulmonary embolism (SPE) is attracting more attention as a special pulmonary sign in severe infection. We aimed to describe the clinical and imaging features of Klebsiella pneumoniae (K. pneumonia)-associated SPE in the emergency department. METHODS: Records of patients with primarily extrapulmonary infection of K. pneumoniae who were admitted to the emergency department between 2014 and 2019 were retrieved. The identifications of K. pneumoniaeassociated SPE were mainly dependent on the clinical manifestations, typical imaging findings, and presence of a primary source of K. pneumoniaeinfection. RESULTS: A total of 33 cases were identified as SPE with extrapulmonary K. pneumoniaeinfection. The main clinical manifestations were a febrile/fragile state (100%), respiratory symptoms (18.2%), and digestive symptoms (33.3%). Eight patients (24.2%) developed septic shock, 2 (6.0%) experienced respiratory failure, and 2 (6.0%) complicated endophthalmitis. The major source of infection was liver abscess (n=26, 78.8%), followed by septicemia (n=8, 24.2%), intestinal infection (n=3, 9.1%), and ascites (n=1, 3.0%). The computed tomography (CT) features included the following: peripheral wedge-shaped opacity (n=12, 36.4%), a feeding vessel sign (n=3, 9.1%), multiple nodular lesions (n=5, 15.2%), multifocal lung ill-infiltrations (n=15, 45.5%), patchy ground-glass opacities (n=6, 18.2%), focal consolidations (n=9, 27.3%), lung abscesses (n=4, 12.1%), and pleural effusion (n=21, 63.6%). Re-examination of lung HRCT conducted in 7 patients demonstrated imaging improvement after treatment. CONCLUSIONS:K. pneumonia-SPE presented special clinical and imaging characteristics, which bear similarities to the signs of pneumonia, but was potentially catastrophic. Identifying SPE in septic conditions is crucial to improving clinical outcomes.