Tropical Medicine Mission Index of Diseases About Tropical Medicine Tropical Medicine Home Page Tropical Medicine Staff

Next Page

Radiological Diagnosis

The radiological findings in pneumonic plague, either primary or secondary, are nonspecific and result from the pathological changes (already described) of rapidly developing pulmonary consolidation, necrosis, and hemorrhage. Initial radiographs of the chest may show patchy segmental or lobar pneumonia similar to pneumococcal or Klebsiella pneumonia. Consolidation may progress rapidly within a matter of hours or days (Fig. 24.7), often to more generalized patchy lobular pneumonitis involving multiple lobes of the same or both lungs. The involved lobe or lobes may be swollen from edema and hemorrhage; there may be radiographic evidence of this increased volume if the consolidation has extended to an adjacent pleural fissure, causing it to become bowed, as seen in Klebsiella pneumonia.

....

...

...

...

Fig. 24.7 Pneumonic plague in a 22-year-old white male laboratory worker who was accidentally exposed to plague bacilli. Serial chest x-rays show an extremely rapidly developing left upper lobe alveolar pneumonia which cleared over a 2 week period with massive antibiotic therapy. (A) 1 September 1959, 1730 hours: the admission chest film shows increased bronchovascular markings in the left upper lobe with an early soft infiltrative process extending from the left suprahilar area to the subclavicular region of the upper lobe. (B) 2 September, 0030 hours: a film 7 hours after admission shows a soft, fan-shaped infiltrate extending into much of the left upper lung field, There are mottled densities in the left mid-lung field as well, representing other areas of lobular pneumonitis. (C) 2 September, 1000 hours: a chest film 18 hours after admission shows diffuse, almost homogeneous opacification involving most of the left upper lobe, except for the lingula and the immediate perihilar area. Note the extremely rapid progression of pneumonic consolidation in only 18 hours. The right lung remains normal. There is a suggestion of early blunting of the left costophrenic angle from minimal pleural effusion. (D) 3 September, 0900 hours: there has been minimal clearing of the extensive left upper lobe pneumonia. The lung appears slightly less opacified, but there is increasing pleural fluid at the left costophrenic angle. (E) 4 September, 1000 hours: there is now definite evidence of partial clearing, although patchy consolidation of much of the left upper lobe remains. A lateral view showed the process to be chiefly in the apical posterior segment of the upper lobe. The left costophrenic angle is now clear. The patient has been on massive antibiotic therapy for almost 3 days. (F) 5 September: there has been further clearing since the film of 24 hours previously. There is soft fine mottling of the left mid- and upper lung field with the heaviest residual infiltrate in the initial area of involvement. (G) 7 September: further clearing is noted with only slight mottled densities seen in the left upper lobe. There is residual consolidation of the original infiltrate in the subclavicular region. (H) 14 September:13 days after admission the left upper lobe is now free of consolidation except for a minimal patchy area in the infraclavicular region. Scattered increase in the linear markings, together with diffuse mottling, is still apparent in the upper lobe, but the inflammatory process is resolving satisfactorily. There is minimal pleural thickening at the left apex. A follow-up film of the chest on 2 October, 31 days after admission, showed virtually complete clearing of the left upper lobe with only a slight diffuse increase in the linear markings in this lobe when compared with the normal right lung. No residual pleural abnormality was present. The mediastinal and hilar lymph nodes showed no evidence of enlargement throughout the patient's illness despite the marked inflammatory process in the left lung. The patient recovered completely without significant sequelae. (Courtesy of Dr. Nelson Blemly).

Back to the Table of Contents

Copyright: Palmer and Reeder