Klebsiella pneumonia causing a bulging fissure

Case contributed by Assoc Prof Craig Hacking

Presentation

Cough and fever.

Patient Data

Age: 60 years
Gender: Male

Consolidation in the right upper lobe with inferior bulging of the horizontal fissure. A central lucency suggests cavitation. Small right pleural effusion.

Case Discussion

Klebsiella pneumoniae was cultured from sputum and the patient recovered well with IV antibiotics. CT (not available) confirmed minor cavitation in the RUL but this resolved with therapy over 4 weeks.

Klebsiella is one of the classic bacteria that causes consolidation with bulging fissures. It is not a very common sign but when seen suggests bacterial etiologies such as Klebsiella and:

  • Streptococcus pneumoniae
  • Pseudomonas aeruginosa
  • Staphylococcus aureus

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