대한흉부영상의학회 Weekly Chest Cases

Courtesy of Yo-Won Choi, M.D. / Hanyang University Hospital, Seoul, Korea
Age/Sex 67 / F
Chief ComplaintAcute fever and blood-tinged sputum. (She is a housewife in the rural area)

Diagnosis: Pulmonary leptospirosis
Radiologic Findings: Chest Radiograph obtained at admission shows diffuse reticular shadow in the whole lung (Fig a). Chest radiograph obtained a day later shows worsening of the lesion (b).
Thin section CT scans obtained on the same day as Fig b show diffuse ground glass opacity in the whole lung. Although the heart appears to be enlarged, pulmonary vascular enlargement, perivascular cuffing, or predominant distribution in the dependent area is not evident, which is against the diagnosis of pulmonary edema.
Brief Review: Differential diagnosis should include ARDS, pulmonary edema, acute infection such as viral pneumonia or Pneumocystis cainii pneumonia, diffuse pulmonary hemorrhage, etc. However, the clinical setting suggests the diagnosis of leptospirosis, which was confirmed by the increased level of antibody titer.
References: Refer to Case 151.
Keywords: Lung, Infection, Bacterial infection,

대한흉부영상의학회 Korean Society of Thoracic Radiology