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The Klebsiella pneumoniae bacillus is a rare cause of acute hematogenous osteomyelitis of long bones. Bony involvement usually develops from a bacteremia associated with a Klebsiella pulmonary or urinary tract infection. Diabetes mellitus, alcoholism, or cirrhosis are predisposing conditions to the development of this form of osteomyelitis. A case report follows in which two sites of Klebsiella osteomyelitis were demonstrated by three-phase bone imaging in a patient with both diabetes and alcoholism.

A 46-year-old male patient with rapidly progressive Klebsiella pneumonia and abscess formation is presented. The infection resulted from a mediastinal-pulmonary fistula that developed during irradiation of a widespread carcinoma of the oesophagus.

The use of combined hepatobiliary-lung imaging in the diagnosis and evaluation of a subphrenic process is described.

In addition to echinococcal cysts and mycetomas, a wide variety of disorders can occasionally produce an air meniscus sign on a chest radiograph. A proposed classification follows: I. Infections A. Lung abscess (with or without pulmonary gangrene) B. Fungus ball C. Bacterial ball D. Tuberculoma E. Blood clot in tuberculous cavity, Rasmussen aneurysm F. Echinococcal lung cyst II. Neoplastic A. Bronchogenic carcinoma B. Primary lung sarcoma C. Metastatic carcinoma, sarcoma to lung D. Bronchial adenoma E. Cystic hamartoma III. Developmental A. Bochdalek hernia (pseudocavity) IV. Traumatic A. Pulmonary hematoma V. Hemodynamic A. Congestive heart failure (with or without bullae)

Excretory urography was performed on 4 patients early in the course of acute pyelonephritis. These studies showed dilatation of the involved collecting system without obstruction. The dilatation resolved after therapy in 3 patients and was not present on a previous excretory urogram in the fourth. Although previous studies have shown that the excretory urogram is usually normal in cases of acute pyleonephritis these cases demonstrate that this disease can produce dilatation of the collecting system and mimic obstruction.

A case is described in which Klebsiella pneumoniae urosepsis associated with acute myocardial infarction resulted in myocardial abscess and papillary muscle rupture. The diagnosis was made during surgery for mitral valve replacement. The patient improved after therapy with cefotaxime; however, cardiac rupture occurred on the sixth postoperative day. The pathogenesis of myocardial abscess and the use of non-invasive techniques for diagnosis are discussed.

While gram-negative pneumonia is a frequent complication in immunosuppressed patients with malignant disease, the diagnosis is difficult to establish. Clinical and radiographic study of 195 episodes of pneumonia in 175 consecutive patients was undertaken. Chest radiographs were negative in 19% of the episodes, probably due to absence of alveolar inflammatory cell infiltrate. Radiographic patterns were classified as either alveolar or mixed alveolar and interstitial; no case of interstitial pattern alone was identified. A positive correlation was found between the neutrophil count and the presence of radiographic abnormalities. The different types of organisms could not be distinguished by the radiographic appearance. The importance of early diagnosis and prompt specific treatment is stressed.

Predisposing factors, onset of symptoms to diagnosis interval, computerized tomography findings and the impact of computerized tomography on the outcome were studied retrospectively in 24 patients with renal or perirenal infections. The most common predisposing factors were diabetes mellitus and urinary tract calculi. The mean interval from the onset of symptoms to diagnosis was 6.8 days. The most common computerized tomography findings were thickening of Gerota's fascia, renal enlargement, focal decreased renal attenuation, perirenal fluid and focal gas. Four patients died despite early diagnosis and appropriate therapy. Computerized tomography aided in the diagnosis, assessment of the extent of disease, treatment and followup. Computerized tomography is the most direct method to evaluate patients with suspected renal or perirenal infection, although mortality may not be altered significantly.

Two patients with splenic abscess successfully diagnosed and treated are described. The first case, a diabetic, developed a pyogenic abscess caused by klebsiella, while the other suffered a splenic infarct complicated by splenic abscess. although relatively easy to treat, solitary abscess of the spleen is a potentially lethal condition due to diagnostic difficulties. In both present instances the final diagnosis was easily achieved before surgery by the aid of computerized tomography (CT). This investigation seems to be more accurate than 99Tcm-sulphur colloid scan and ultrasound scan, which failed in both cases to diagnose splenic abscess clearly. The use of this investigation is suggested in every suspected case and will, no doubt, confirm the diagnosis at an early stage of the disease. Splenectomy with antibiotic cover will usually result in cure.

Although urinary tract infection occurs in approximately one-third of symptomatic patients with medullary sponge kidney (MSK), renal abscess is a rare complication of the disorder. We describe two patients with MSK complicated by renal abscesses that were diagnosed by CT. The diagnosis of renal abscess should be suspected in patients with MSK and acute pyelonephritis who do not respond to appropriate antibiotic therapy, and renal CT should be done. Computed tomography may show large abscesses that require percutaneous or open surgical drainage or small abscesses that require prolonged high dose antibiotic therapy.

The initial chest radiographs of 31 patients with laboratory-proved pneumonia were evaluated by a panel of 6 radiologists who had no prior knowledge of the clinical data. No statistical reliability was found for distinguishing bacterial from nonbacterial pneumonia. Radiographic diagnoses were 67% accurate for the 16 cases of bacterial pneumonia, and 65% accurate for the 9 viral cases. Six cases of Mycoplasma pneumonia were diagnosed as nonbacterial 19% of the time, and as "bacterial pneumonia" 81% of the time.

The computed tomographic (CT) scan appearance of parenchymal central nervous system (CNS) infection in 12 immunosuppressed patients was unlike that of the usual bacterial abscess in immunologically intact hosts. The lesions were poorly circumscribed and of low density. Contrast enhancement was minimal and did not assume a "ring" configuration. These CT scan findings heralded a poor prognosis. Compared to the neuropathologic findings, the CT scan generally underestimated the extent of involvement. Three other compromised patients were better able to localize the infection. This successful defense was manifested on their CT scans as the more typical "ring" pattern of contrast enhancement. Patients with this CT scan appearance of their CNS infection had a better prognosis.

Acute focal bacterial nephritis, synonymous with acute lobar nephronia or focal nonliquefactive pyelonephritis, represents a localized area of renal inflammation. Clinically, acute focal bacterial nephritis presents as acute pyelonephritis but is distinguishable by the presence of a focal mass on excretory urography. The further distinction between acute focal bacterial nephritis and other renal masses is aided by the appropriate use of renal sonography and computerized tomography. The clinical and imaging manifestations in 9 patients with acute focal bacterial nephritis are described. Our experience coupled with a review of the literature suggests that a systematic approach to the diagnosis and management of acute focal bacterial nephritis allows for the most efficacious use of the noninvasive imaging modalities.

Under the influence of antibiotic therapy, bacterial pneumonias have undergone a remarkable change in the last few decades. Individual forms of pneumonia can be distinguished morphologically by their localization, the way in which they spread, their limitations, and their course. Clinically, opportunistic bacterial infections predominate. Increasingly, secondary pneumonias are observed in poststenotic areas, areas of infarction, in hypostatic areas, after aspiration, and in previously damaged lobes. Radiologic criteria for differentiating from atypical pneumonias (viruses, mycoplasmas and chlamydia) are discussed.

All cases referred for computed tomography (CT) from a 48-bed infectious disease unit over a 3-year period were reviewed. Thirty patients were examined on 45 occasions with head and body cases approximately equal in number. Positive diagnoses were made in 38 examinations (84%), although this included 3 incidental findings. The most common indication for CT was exclusion of cerebral abscess presenting as meningitis (11 cases). The most common disease was tuberculosis (12 cases), although a wide spectrum of disease including four noninfective cases was encountered. CT made a direct contribution to the management of patients with meningitis, encephalitis, cerebral abscess, septicemia, hepatic abscess, tuberculosis, and lymphoma. Although CT was only utilized in a small proportion of patients admitted to this unit, the technique provided valuable information in the management of a number of problematic cases.