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Weekly Chest CasesImaging Conference Cases

Case No : 6

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

Courtesy
Asan Medical Center, Seoul Korea
Imaging Findings
Chest radiographs at 3 days and 6 days after initial evaluation
Chest radiograph (admission)

Bilateral patchy GGO

Non-lobar and peripheral distribution

Normal range of heart size


High resolution CT (admission)

Centrilobular GGO

Centrilobular nodules

Smooth interlobular septal thickening


Chest radiograph (#0 ~ #2)

Rapid progression of pulmonary infiltration and confluent consolidation

Laboratory findings

Azotemia, thrombocytopenia, hyperbilirubinemia

Antibody

Leptospiral antibody; positive (1: 1280)

Hantavirus, rickettsia, antimycoplasma, legionella, CMV, parainfluenza, PCP; all negative


Bronchoscopy

Diffuse hemorrhage from bronchial tree
Discussion
Leptospira interrogans - Leptospira icterohaemorrhagiae strain

Rodents and domestic animals - Direct contact / indirect (urine)

Involved organs - Liver, kidneys, muscles, CNS, lung (38-66%)

Pulmonary hemorrhage - Direct injury of capillary wall due to toxic substance


Radiologic Findings

Abnormalities on chest radiograph (64%)

Non-lobar and bilateral distribution (100%)

Mainly peripheral lung (50%)

Three patterns
Multiple nodular opacities with or without focal areas of consolidation (57%)
Large confluent areas of consolidation (16%)
Diffuse, ill-defined areas of GGO (27%)

Small pleural effusion (19%), cardiomegaly (27%)
Reference
Leptospira interrogans - Leptospira icterohaemorrhagiae strain

Rodents and domestic animals - Direct contact / indirect (urine)

Involved organs - Liver, kidneys, muscles, CNS, lung (38-66%)

Pulmonary hemorrhage - Direct injury of capillary wall due to toxic substance


Radiologic Findings

Abnormalities on chest radiograph (64%)

Non-lobar and bilateral distribution (100%)

Mainly peripheral lung (50%)

Three patterns
Multiple nodular opacities with or without focal areas of consolidation (57%)
Large confluent areas of consolidation (16%)
Diffuse, ill-defined areas of GGO (27%)

Small pleural effusion (19%), cardiomegaly (27%)
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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