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Objective:
To display various imaging manifestations of chest and other parts of the body in melioidosis patients with bacteremia or septicemia.

Materials and Methods:
We collected 113 cases of melioidosis with chest imaging examination data from August 2001 to December 2021, among which 79 cases were confirmed (68.1%) by blood culture, and the rest were confirmed by sputum culture, pus culture, urine culture, etc. There were 22 deaths with septicemia, accounting for 19.5% of all cases, and 27.8% of bacteremia cases. Of the 113 cases, 26 had only chest x-ray; 69 had chest CT; 18 had both chest x-ray and CT. Among 113 cases, 53 patients had imaging examinations of the abdomen, skull, bone and joints and so on. Two radiologists independently observed the chest imaging findings of 113 melioidosis cases without information of the laboratory findings. Discussion was held for two independent observation results. If there were inconsistent results for the same case, another senior doctor was requested to review the results; agreement by two of the three observers was accepted. The chi-square test was used to count the incidence of various radiographic findings in melioidosis patients with or without blood involved, with a statistical significant p - value of <0.05.

Results:
Among 113 patients with melioidosis with chest imaging, the most common chest imaging findings were (1) multiple nodules in bilateral lungs and subpleuras (61 /113, 54.0%); ground glass opacity(GGO) and/or ground glass nodule(GGN) (56 / 113, 49.6%), and one or bilateral pleural effusion (54 / 113, 47.79%). Compare the chest manifestations of melioidosis patients with and without bacteremia, the above lesions were significantly more common in the patients with bacteremia group than in the nonbacteremia group. Of the 79 blood culture-positive melioidosis patients 52 showed multiple nodules in lungs and subpleuras (65.8%), significantly more than those without hematogenous dissemination (9 / 34, 26.5%), (p < 0.005); 43 (54.4%) showed one or two side pleural effusion; also significantly more than those without hematogenous dissemination (11/34, 32.4%), (p < 0.05);44 showed GGO and/or GGN (55.7%), significantly more than those without hematogenous dissemination (13/34, 35.1%), (p < 0.05);. Other manifestations, such as cavity, consolidation, mediastinal lymph node enlargement, centrilobular nodules, and there was no difference between bacteremia and nonbacteremia. Infections in other parts of the patients, such as spleen and/or liver abscess, osteomyelitis, pseudoaneurysm and so on were observed as well.

Conclusion:
Common chest imaging findings in melioidosis patients were multiple nodules in bilateral lungs and subpleuras, GGO and/or GGN, and one or both side pleural effusion. The incidence of chest lesions was significantly higher in melioidosis patients with bacteremia compared to those without bacteremia,and pulmonary abnormalities combined with infection in other parts suggest that bacteremia is more likely, these should be prompt for clinical hematological examination in time.