Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

Chou, Deng-Wei; Wu, Shuling; Chung, Kuo-Mou; Han, Shu-Chen

doi:10.6061/clinics/2015(06)03

Cited by 36 publications

(36 citation statements)

References 35 publications

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“…In addition, Nguyen et al reported CT findings, including consolidations, multiple nodules and GGA, from nine patients with community-acquired MRSA pneumonia 23 . SPE can present as consolidations, multiple nodules with cavities and GGA in CT images 6 , all of which are present in pneumonia, thus making distinguishing SPE from pneumonia difficult. In the present study, CT examinations showed multiple different sizes of nodules with cavities, as shown in Figure 2 , which is suggestive of SPE instead of pneumonia.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients with SPE are diagnosed on the basis of CT findings and the presence of a primary source of infection 2 – 4 because histopathological confirmation is typically unfeasible in clinical practice 2 . The clinical presentations of SPE range from insidious illness with mild respiratory symptoms to respiratory failure and septic shock 6 . Despite its life-threatening nature, data on patients with SPE who require critical care have not been well reported.…”

Section: Introductionmentioning

confidence: 99%

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Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

Chou¹,

Wu²,

Chung³

et al. 2016

Clinics

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OBJECTIVES:Septic pulmonary embolism is an uncommon but life-threatening disorder. However, data on patients with septic pulmonary embolism who require critical care have not been well reported. This study elucidated the clinicoradiological spectrum, causative pathogens and outcomes of septic pulmonary embolism in patients requiring critical care.METHODS:The electronic medical records of 20 patients with septic pulmonary embolism who required intensive care unit admission between January 2005 and December 2013 were reviewed.RESULTS:Multiple organ dysfunction syndrome developed in 85% of the patients, and acute respiratory failure was the most common organ failure (75%). The most common computed tomographic findings included a feeding vessel sign (90%), peripheral nodules without cavities (80%) or with cavities (65%), and peripheral wedge-shaped opacities (75%). The most common primary source of infection was liver abscess (40%), followed by pneumonia (25%). The two most frequent causative pathogens were Klebsiella pneumoniae (50%) and Staphylococcus aureus (35%). Compared with survivors, nonsurvivors had significantly higher serum creatinine, arterial partial pressure of carbon dioxide, and Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, and they were significantly more likely to have acute kidney injury, disseminated intravascular coagulation and lung abscesses. The in-hospital mortality rate was 30%. Pneumonia was the most common cause of death, followed by liver abscess.CONCLUSIONS:Patients with septic pulmonary embolism who require critical care, especially those with pneumonia and liver abscess, are associated with high mortality. Early diagnosis, appropriate antibiotic therapy, surgical intervention and respiratory support are essential.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

Chou¹,

Wu²,

Chung³

et al. 2016

Clinics

Self Cite

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“…The most common sources are liver abscess (50%) and pneumonia (25%). Acute kidney injury, disseminated intravascular coagulation and lung abscesses are common in non-survivors [31,32].…”

Section: Pulmonary Thromboembolismmentioning

confidence: 99%

Cardiac arrest among patients with infections: causes, clinical practice and research implications

Leoni

Rello

2017

Clinical Microbiology and Infection

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The incidence of sepsis is increasing, and the condition is now the leading cause of death in general intensive care units. Our review failed to identify studies of the causes of cardiac arrest among infected patients, even though non-cardiac causes represent 15% of out-of-hospital cardiac arrests and though one-third of events have positive blood cultures. Sudden cardiac arrest is the result of local damage to the heart and of the impact of systemic and pulmonary conditions on cardiac performance, and its danger is underestimated. Necropsy findings in sudden death often identify myocarditis as an unexpected cause. The role of hypoxaemia, severe pulmonary thromboembolism with subsequent pulseless cardiac activity, alterations of electrolytes and hydrogen concentrations, distort fluid distribution with reduced pre-load, direct myocyte damage and adverse cardiac effects related to antibiotic use need to be defined. Many cardiac arrests might be preventable. Because cardiopulmonary resuscitation is challenging and usually unsuccessful in patients with sepsis, research is needed to help predict which patients are at risk. Only half of pneumonia patients with cardiac arrest in the ward receive prior ECG monitoring. Telemedicine and non-invasive monitoring in the ward, avoidance of antibiotics associated with prolonged QT syndrome, and adequate haemodynamic resuscitation might be important in preventing in-hospital arrests among patients with infections.

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“…1,2 The patients may present with insidious respiratory illness with fever and breathlessness which may also deteriorate leading to acute respiratory failure, septic shock, multiorgan dysfunction syndrome and systemic inflammatory response syndrome. 3 Symptoms cover the entire spectrum from asymptomatic patients to sudden death. 1 The source of infection is of wide range and most common source of septic embolism in lung is being infective foci in right heart (eg.…”

Section: Introductionmentioning

confidence: 99%

A Study of Radiological Appearances of Septic Pulmonary Embolism in Contrast Enhanced Computed Tomography Thorax

Shah¹,

Priyanka²,

Desai³

2020

IJCMR

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Introduction: Septic embolism, though dangerous and life threatening the number of cases reported are seldom. To diagnose septic embolism clinic-radiological correlation is must. Study aimed to depict various radiological appearances of septic thromboembolism according to there frequency of occurence and using clinical history to strengthen the suspicion of SPE in patients as SPE have grave prognosis if not detected early. Material and methods: Study was done in the Government Medical College Surat including the subjects of clinically suspected septic pulmonary thromboembolism and studying the radiological pattern of their presentation during the year 2018-2019. Results: In this study the most common radiological presentation is feeding vessel sign seen in (90%) of patients CT, the most common cause is liver abscess constituting (40%) of cases, the most common primary cause in the patients with complications and mortality is pneumonia and most common sequelae is acute respiratory failure constituting (66%) of mortality and most common chronic ailment association is diabetes mellitus seen in (60%) of patients. Conclusion: Septic pulmonary embolism is life threatening but diagnosis is difficult as there are no specific clinical complaints and radiological features but for benefit of patient quick diagnosis and management must be started as it has high mortality rate. SPE should be considered in the differential diagnosis of patients presenting extrapulmonary infective focus, respiratory symptoms, and parenchymal pulmonary nodules on imaging studies of the chest

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Septic pulmonary embolism caused by a Klebsiella pneumoniae liver abscess: clinical characteristics, imaging findings, and clinical courses

Cited by 36 publications

References 35 publications

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

Septic Pulmonary Embolism Requiring Critical Care: Clinicoradiological Spectrum, Causative Pathogens and Outcomes

Cardiac arrest among patients with infections: causes, clinical practice and research implications

A Study of Radiological Appearances of Septic Pulmonary Embolism in Contrast Enhanced Computed Tomography Thorax

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