Archive of Old Cases
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- Archive of Old Cases
- 2008
Case No : 579 Date 2008-12-01
- Courtesy of Jong Heon Park, MD, Tae Sung Kim, MD. / Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea.
- Age/Sex 30 / M
- Chief ComplaintFever, Chilling, Myalgia / He is in construction. Recently, he frequently went to the mountains and fields.
Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pulmonary leptospirosis
- Radiologic Findings
- Fig 1. Chest PA shows diffuse nodular opacities in both lung.
Fig 2. HRCT show extensive bilateral pulmonary opacities are composed of various patterns of lung abnormalities. Bilateral pleural effusions are associated.
Fig 3. F/U chest PA after 10 days show improvement of parenchymal opacities in both lung.
- Brief Review
- Leptospirosis is the disease produced by any of the group of spirochetes of the genus Leptospira. The main organs involved are the liver, central nervous system, kidneys, skeletal muscle, and lungs. Thirty-seven (64%) of 58 patients with leptospirosis, proved by positive serology, had pulmonary radiographic findings. Three radiographic patterns were evident: (1) 21 (57%) of the 37 patients had small nodular densities, (2) six (16%) had large confluent areas of consolidation, and (3) 10 (27%) had diffuse, ill-defined, ground-glass density. Serial radiographs showed a tendency for the nodular pattern to be followed by confluent consolidation and/or ground-glass density. Abnormalities were bilateral, nonlobar in all cases, and had a marked tendency toward peripheral predominance. Pulmonary abnormalities resolved within 15 days, except in eight patients who died because of respiratory failure (six patients) or other causes (two patients). In order to correlate pathology with the radiographic findings, Leptospira, isolated from a patient, was injected intraperitoneally into 20 guinea pigs. All lungs from the guinea pigs showed petecheal hemorrhage, which progressed to large confluent areas of hemorrhage. The typical pulmonary radiographic findings of leptospirosis are compatible with the multifocal pulmonary hemorrhage.
- References
- 1. Leptospirosis of the lung: radiolographic findings in 58 patient. AJR 152:955-959, May 1989
- Keywords
- Lung, Infection, Bacterial infection,
No. of Applicants : 83
- ▶ Correct Answer : 24/83, 28.9%
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- - Samsung Medical Center , Korea (South) Dae Kun Oh
- - Osaka University , Japan Osamu Honda
- - Chungnam National University hospital , Korea (South) Kyoung Jin Oh
- - Seoul National University Hospital , Korea (South) Sang Min Lee
- - China Medical University,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
- - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
- - Samsung Medical Center , Korea (South) Eun Kim
- - Shinsegye Rad Clinic, Daegu , Korea (South) Gi Beom Kim
- - partner, aditya imaging centre , India vivek patel
- - wonju christial hospital , Korea (South) Daekeon Lim
- - Mackay Memorial Hospital , Taiwan Shen ShengYeh
- - Gimpo Woori Hospital , Korea (South) Son Youl Lee
- - Soonchunhyang university Bucheon hospital , Korea (South) Minhee Lee
- - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
- - Clinic 1 , Russian Federation Lepikhina Darya
- - Govt. Medical College, Vadodara, india , India Vijay Vaidya
- - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
- - second hospital xian jiaotong university , China li ming
- - Soonchunhyang university hospital, Bucheon , Korea (South) ALEUM LEE
- - Dongguk University International Hospital , Korea (South) Hee Seok Choi
- - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
- - radiology department ANNECY , France gilles GENIN
- - The Armed Forces HamPyeong Hospital , Korea (South) Bae Geun Oh
- - Armed Forces Chun-Cheon Hospital , Korea (South) ChaeHun Lim
- ▶ Correct Answer as Differential Diagnosis : 11/83, 13.3%
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- - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
- - Cheongshim international medical center , Korea (South) Hae Jum Yang
- - Seoul National University Hospital , Korea (South) Kwang Nam Jin
- - CHRU lille , France manuel toledano
- - hospital Sao Paulo , Brazil israel missrie
- - IRSA La Rochelle France , France Denis Chabassiere
- - Asian Heart Institute, Nirman Hitech & Apollo clinic , India Jeshil Shah
- - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- - Yonsei University college of medicine Severance Hospital , Korea (South) Hua Sun Kim
- - Hanmaeum Hospital , Korea (South) Kwon Hyoung Kim
- - jiangsu province hospital , China yuan doctor
- ▶ Semi-Correct Answer : 19/83, 22.9%
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- - Shiga University of Medical Science , Japan Norihisa Nitta
- - Ruby Hall Clinic , India john joseph
- - CHRU Lille , France Benjamin Damarey
- - National Taiwan University Hospital , Taiwan Chin-Chung Shu
- - Assam medical college , India Karunakaran M
- - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
- - Father Muller Medical College , Mangalore , India nabil mahmood
- - Marien Hospital, Hamm , Germany Davis Chiramel
- - McGill University Health Centre , Canada Amr Ajlan
- - UZ Gent , Belgium Robert Gosselin
- - Seoul national university , Korea (South) JAE LEE
- - Homs National Hospital , Syria Rami Abou Zalaf
- - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
- - Soonchunhyang University Cheonan Hospital , Korea (South) Park Sang Hyun
- - Vitalife Clinics , Pune , India. , India Rahul Deshmukh
- - CHU Grenoble , France Fabrice Bing
- - McGill University Health Center , Canada Alexandre Semionov
- - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
- - E-DA Hospital / I-Shou University , Taiwan Yu-Feng Wei
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