title: Computed Tomography Features of Septic Pulmonary Embolism Caused by Klebsiella pneumoniae Liver Abscess Associated With Extrapulmonary Metastatic Infection.
abstract: OBJECTIVE
  The aims of the study were to investigate the computed tomography (CT) features and clinical course of septic pulmonary embolism (SPE) caused by Klebsiella pneumoniae liver abscess (KPLA) and to explore the possible mechanism underlying the spread of infection.
  
  
  METHODS
  Twenty-one patients with KPLA-induced SPE admitted to our hospital between January 2010 and May 2015 were evaluated. According to the presence or absence of extrapulmonary metastatic infection (EMI), they were divided into EMI and non-EMI groups and clinical and CT features of the 2 groups were compared. Hepatic vein thrombophlebitis was evaluated on liver CT images. Chest CT features included nodules, wedge-shaped lesions, ground-glass opacity, consolidation, cavitation, feeding vessel sign, pleural effusion, and lymphadenopathy.
  
  
  RESULTS
  All the vessels within the so-called feeding vessel sign were confirmed as pulmonary veins by multiplanar reconstruction, so we used an alternative name draining vessel sign (DVS) instead. Peripheral nodules, DVS, and consolidation were the main CT features of KPLA-induced SPE. Peripheral nodules and DVS were more frequently seen in the EMI group than in the non-EMI group (P = 0.019 and 0.008, respectively). Five of 8 patients with hepatic vein thrombophlebitis had lung consolidation, whereas only 3 of 13 patients without hepatic vein thrombophlebitis had lung consolidation, although the difference was not significant (P = 0.09).
  
  
  CONCLUSIONS
  Multiple pulmonary nodules and DVS were associated with EMI. Hepatic and pulmonary vein invasion are possible causes underlying the metastatic spread of infection.
authors.affiliation: From the Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
authors.forename: Zhihui
authors.initials: Z
authors.lastname: Chang
authors.forename: Zheng
authors.initials: Z
authors.lastname: Gong
authors.forename: Jiahe
authors.initials: J
authors.lastname: Zheng
authors.forename: Yujia
authors.initials: Y
authors.lastname: Ma
authors.forename: Zhaoyu
authors.initials: Z
authors.lastname: Liu
mesh_terms: D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000000981:diagnostic imaging*; D007711:Klebsiella pneumoniae; D046290:Liver Abscess, Pyogenic / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging*; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging*; D018805:Sepsis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed