Chest x-rays of Klebsiella pneumoniae

(Panels A and B) A-43 year-old diabetic man with alcoholism presented with intermittent fever for five days and dyspnea for one day prior to admission. Mild ketoacidosis was observed. Chest film initially demonstrated bilateral patchy infiltration (panel A), followed by rapid extensive consolidation, particularly of right upper lobe three hours later (panel B). Acute respiratory distress syndrome ensued and the patient died within 12 hours of admission despite appropriate antimicrobial therapy and aggressive hemodynamic support in the intensive care unit. Blood and sputum cultures yielded K. pneumoniae.
(Panels C and D) A 64-year-old woman with K. pneumoniae bacteremia and right upper lobe pneumonia; the patient died of extensive pneumothorax following two weeks in intensive care unit (panel C). A 52-year-old man with chronic alcoholism presented with K. pneumoniae bacteremia and right upper lobe pneumonia; he developed acute respiratory distress syndrome with profound septic shock and died within 24 hours of admission (panel D). These radiographs demonstrate the predilection for involvement of the posterior segment of the right upper lobe in K. pneumoniae community-acquired pneumonia as well as the bulging fissure sign, characterized by bowing of the fissure downward due to intense consolidation.