Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses.
Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses.
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DOI：
10.6061/clinics/2015(06)03
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发表时间：
2015-06
期刊：
影响因子：
--
通讯作者：
Han SC
中科院分区：
文献类型：
--
作者：
Chou DW;Wu SL;Chung KM;Han SC
由克雷伯氏菌（K.）肺炎性肝脓疡是一种罕见的疾病，但却能引起相当高的发病率和死亡率。然而，关于这种情况的临床信息有限。本研究旨在阐明全疾病谱，以改善其诊断和治疗。我们回顾了14例诊断为肺炎克雷伯菌感染性肺栓塞患者的临床特征、影像学表现和临床病程。肺炎肝脓肿9年。两个最普遍的症状是发烧和呼吸急促。CT表现包括供血血管征（79%）、有或无空洞的结节（79%）、胸腔积液（71%）、周围楔形阴影（64%）、斑片状毛玻璃影（50%）、结节内支气管充气征（36%）、实变（21%）、晕征（14%）和肺水肿（14%）。9名（64%）患者出现严重并发症，需要重症监护。根据随访胸片，浸润和实变在两周内消退，结节性阴影在一个月内消退。2例（14%）患者死于感染性休克; 1例患者患有转移性脑膜炎，另1例患有转移性心包炎。临床表现包括潜伏性疾病伴发热和呼吸道症状、呼吸衰竭和感染性休克。广泛的影像学表现，从结节到多发性实变，被检测到。感染性肺栓塞是由一种克雷伯氏菌引起的。肺炎性肝脓肿合并其他重要器官的转移性感染预后差。
Septic pulmonary embolism caused by a Klebsiella (K.) pneumoniae liver abscess is rare but can cause considerable morbidity and mortality. However, clinical information regarding this condition is limited. This study was conducted to elucidate the full disease spectrum to improve its diagnosis and treatment. We reviewed the clinical characteristics, imaging findings, and clinical courses of 14 patients diagnosed with septic pulmonary embolism caused by a K. pneumoniae liver abscess over a period of 9 years. The two most prevalent symptoms were fever and shortness of breath. Computed tomography findings included a feeding vessel sign (79%), nodules with or without cavities (79%), pleural effusions (71%), peripheral wedge-shaped opacities (64%), patchy ground-glass opacities (50%), air bronchograms within a nodule (36%), consolidations (21%), halo signs (14%), and lung abscesses (14%). Nine (64%) of the patients developed severe complications and required intensive care. According to follow-up chest radiography, the infiltrates and consolidations were resolved within two weeks, and the nodular opacities were resolved within one month. Two (14%) patients died of septic shock; one patient had metastatic meningitis, and the other had metastatic pericarditis. The clinical presentations ranged from insidious illness with fever and respiratory symptoms to respiratory failure and septic shock. A broad spectrum of imaging findings, ranging from nodules to multiple consolidations, was detected. Septic pulmonary embolism caused by a K. pneumoniae liver abscess combined with the metastatic infection of other vital organs confers a poor prognosis.
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