Klebsiella pneumoniae pneumonia with neck infection and septic thrombosis

Case contributed by Dr Maria Grazia Papi

Presentation

Fever, productive cough, and a lesion within the superficial soft tissues of the neck, likely of inflammatory origin.

Patient Data

Age: 50 years
Gender: Female

Bilateral pneumonic consolidation with a random distribution associated with small areas of ground-glass attenuation, extensive smooth bronchial wall thickening, and interlobular septal thickening.

Contrast-enhanced CT neck:
Necrotic, colliquative areas delimited by an enhancing border within the soft tissue of the posterior left lateral aspect of the neck. Intraluminal filling defect within the left internal jugular vein, in keeping with septic thrombus.

Eight days after admission, there is evidence of disease progression with a new finding of cavitation superimposed on a right middle lobe (RML) consolidation, with worsening of the centrilobular nodules, the bronchial wall thickening and the ground glass attenuations. Bilateral pleural effusion, moderate amount, right larger than left.

Interval imaging comparison of CT chest studies (day 3 and day 8)

Annotated image

Interval comparison between the first (3 days after admission) and the second (5 dayslater) CT chest studies, at same imaging level: there is evidence of progressive cavitation within a previous lung consolidation, suggesting necrotizing pneumonia (red arrows).

Rapid progression of the disease. Widespread small airways opacification bilaterally. In the right middle-lower zone, there is evidence of lung consolidation associated with lucent areas likely represeting cavitation. Features of acute respiratory distress syndrome (ARDS) with massive bilateral airspace filling and normal cardiac size.

Microculture sensitivities from bronchoalveolar lavage and central line tip samples positive for Klebsiella pneumoniae.

Case Discussion

Accordingly with other scientific studies, in this case of Klebsiella pneumoniae pneumonia (KPP) (combined with concurrent infections) there were a dramatic onset and a progressive worsening of the respiratory conditions and of the radiologic findings, accordingly, in spite of the prompt diagnosis and therapy. In the last stage, the radiological features were of acute respiratory distress syndrome (ARDS) with pulmonary edema.

In this patient, a particular pattern of KPP infection spreading from an inflammatory lesion of the neck soft tissues through a septic thrombosis of the internal jugular vein to the lungs has been hypothesized. The CT studies and plain radiographs of the chest resembled those described in other scientific works with the main features of this lung infection being cavitation superimposed on the previous consolidation, suggesting necrotizing pneumonia, associated with pleural abnormalities and poorly confined lung infiltrates.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.