Imaging analysis of pneumonic plague infection in Xizang, China: two case reports and literature review

Abstract Background Plague is an acute infectious disease caused by the Yersinia pestis. Historically, it has been a major pandemic with high mortality rates, known as the "Black Death" in the 14th century, which resulted in millions of deaths in Europe. With increasing economic prosperity, more and more people are traveling to Xizang. However, this trend also hides significant safety hazards. Currently, there are few recent reports on plague, especially those with imaging manifestations available. In this study, we report the detailed clinical and radiographic data of two patients with pneumonic plague in Xizang, China, in 2023. Case presentation: We report two cases of pulmonary plague in Xizang, with both patients were herdsmen living in an area where dead marmots were found. Both patients presented with symptoms such as fever, hemoptysis, dyspnea and coma. Chest computed tomography (CT) scans showed multiple nodules distributed in the central regions of lung lobes, consolidation distributed in secondary pulmonary lobules, and had a gravity-dependent distribution pattern. One patient developed pleural effusion. These imaging findings are consistent with pulmonary hemorrhage and diffuse alveolar damage. Despite emergency treatment, both patients died within 24 hours of admission. Through retrospective medical history investigation and autopsy, the final diagnosis was confirmed as pulmonary plague. Conclusion Pneumonic plague is the most deadly infectious disease, and its pathological features are mainly include damage to the alveoli, pulmonary hemorrhage, and pulmonary edema. Corresponding to CT, it manifests as acute and rapidly progressing pneumonia, alveolar damage, and pulmonary hemorrhage. The value of this article lies in the completeness and typicality of the imaging data, vivid hand-drawn illustrations of transmission pathways, and comprehensive literature review, all of which serve to enhance public understanding of plague and play an important warning role.