Community-acquired methicillin-resistant Staphylococcus aureus pneumonia: radiographic and computed tomography findings

Elsie T Nguyen, Jeffrey P Kanne, Linda M N Hoang, Steven Reynolds, Vinay Dhingra, Elizabeth Bryce, Nestor L Müller
Journal of Thoracic Imaging 2008, 23 (1): 13-9

OBJECTIVE: The aim of our study was to review the radiologic findings of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia.

MATERIALS AND METHODS: The hospital infection control computer database was used to identify patients who had a CA-MRSA infection with organisms isolated from blood, bronchoalveolar lavage fluid, or pleural fluid samples. Criteria for CA-MRSA pneumonia were consolidation seen on chest radiography or computed tomography (CT), growth of MRSA from sputum and/or sterile pulmonary site, clinical complaints of cough and/or shortness of breath. Chest radiographs and CT scans for 9 patients (5 men, mean age 45 y, range 35 to 71 y) were retrospectively reviewed by 2 chest radiologists.

RESULTS: The most common chest radiographic finding was consolidation, which was bilateral in 7 patients and unilateral in 2 patients. The consolidation was patchy and nonsegmental in 5 and segmental in 4 patients. Two patients had cavitation evident on the chest radiograph. The most common CT scan findings were bilateral (n=8), often symmetric (n=5) consolidation, bilateral septal lines (n=7), and multiple nodules (n=5). Cavitation was present in 5 patients, either in regions of consolidation (n=5) or in large nodules (n=3). Five patients with CA-MRSA pneumonia had rapid clinical deterioration requiring ventilatory support. Two patients died.

CONCLUSIONS: CA-MRSA pneumonia is characterized by extensive bilateral consolidation and frequent cavitation and is commonly associated with rapid progression and clinical deterioration. CT is superior to radiography in demonstrating the presence of cavitation.

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