Pulmonary melioidosis: clinical-radiologic correlation in 183 cases in northeastern Thailand.

The chest radiographs of 183 patients with pulmonary melioidosis seen over a 4-year period were evaluated retrospectively. Disseminated nodular lesions occurred in 46 of 55 patients (84%) with the acute septicemic form of the disease and in 17 of 31 (55%) with the subacute or chronic form and positive blood cultures. Alveolar lesions occurred in 26 of 50 patients (52%) with the acute pneumonic form. There was no typical pattern of pulmonary infiltrates in 16 patients with the subacute pneumonic form, but in the chronic form, 17 of 31 patients (55%) had mixed infiltrates with cavities. The lesions were confluent in the upper lobes but tended to spare the apices in nonsepticemic cases. Rapid progression and early cavitation are distinctive features in acute cases, but in chronic cases the lesions may remain unchanged up to 20 months. Pleural effusion or empyema was seen in 22 of 105 patients (21%) with acute disease and four of 31 (13%) with chronic disease. Six of 105 patients (6%) with acute disease and three of 31 (10%) with subacute or chronic disease and positive blood cultures had pericardial involvement.