대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

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,