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대한흉부영상의학회 Weekly Case 검색
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Weekly Chest CasesImaging Conference Cases

Case No : 3

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  • Age/Sex 80 / M
  • Case Title Cough and blood-tinged sputum, fever and chill (5 days)
  • Figure 1
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Diagnosis With Brief Discussion

Courtesy
Asan Medical Center, Seoul Korea
Lab
Laboratory evaluation

Bronchoscopy--Diffuse alveolar hemorrhage

Microbiology test

Legionella Ag; negative

Leptospiral Ab: positive

Hantanvirus Ab; negative

Richettsia Ab; negative

FU Leptospiral Ab; positive 1:1280
Discussion
The group of spirochetes of the Leptospira genus, 180 serotypes and 18 pathogenic for humans or animals

-Organisms: As parasite of rodents and of many domestic animals (dogs, pigs, horses).

-Agricultural workers, pet shop owners


Pathologic findings: petechial hemorrhage in the lungs


Radiologic findings

-Multiple nodular opacities (air space nodules) ranging 1-7 mm in diameter

-Large confluent areas of consolidation

-Diffuse, ill-defined areas of ground-glass opacity

-Small pleural effusion

-Cardiomegaly


Clinical manifestation: Renal and hepatic failure, Pulmonary disease (ARDS or diffuse lung hemorrhage)

-Headache, chill, nausea and vomiting, pyuria, hematuria, hepatomegaly

-Cough, Hemoptysis


Diagnosis: Culture of organism from blood and urine, serologic test


Radiologic differential diagnosis

-Diffuse pulmonary hemorrhage

--Wegener뭩 granulomatosis

--Churg-Strauss syndrome

--Collagen vascular disease

--Infectious condition: Leptospirosis?

-Viral pneumonia

-Hypersensitivity pneumonitis

-Pulmonary edema
Keywords
Lung, Infection, Bacterial infection,
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Current Editor : Sung Shine Shim, MD, PhD. Email : sinisim@ewha.ac.kr

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