Klebsiella pneumoniae pneumonia with neck infection and septic thrombosis

Bibasal small airways opacification. Blunting of the left costophrenic angle.

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 & day 8

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

Rapid progression of the disease. Widespread small airway opacification bilaterally. In the right middle-lower zone, there is evidence of lung consolidation associated with lucent areas likely representing 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.