Pulmonary Leptospirosis With Diffuse Alveolar Hemorrhage: High-Resolution Computed Tomographic Findings in 16 Patients

• Published in: Journal of computer assisted tomography Vol. 40; no. 1; pp. 91 - 95
• Main Authors: von Ranke, Felipe Mussi, Zanetti, Gláucia, Escuissato, Dante Luiz, Hochhegger, Bruno, Marchiori, Edson
• Format: Journal Article
• Language: English
• Published: United States 01-01-2016
• Subjects: Adult; Diagnosis, Differential; Female; Hemorrhage - complications; Hemorrhage - diagnostic imaging; Hemorrhage - microbiology; Humans; Leptospira; Leptospirosis - complications; Leptospirosis - diagnostic imaging; Lung - diagnostic imaging; Lung - microbiology; Lung Diseases - complications; Lung Diseases - diagnostic imaging; Lung Diseases - microbiology; Male; Middle Aged; Pulmonary Alveoli - diagnostic imaging; Retrospective Studies; Tomography, X-Ray Computed; Young Adult
• ISSN: 0363-8715; 1532-3145
• DOI: 10.1097/RCT.0000000000000318

The aim of this study was to evaluate the high-resolution computed tomographic (HRCT) findings from patients with leptospirosis and diffuse alveolar hemorrhage (DAH).
We retrospectively reviewed HRCT findings from 16 patients diagnosed as having leptospirosis causing DAH. The patient sample was composed of 13 men and 3 women aged 22 to 53 years (mean age, 34.5 years). Diagnosis was established with confirmation of leptospirosis infection by serologic microagglutination test. Histopathological study was performed in 8 patients. Two chest radiologists analyzed the HRCT images and reached decisions by consensus.
The predominant HRCT findings were ground-glass opacities and airspace nodules (both n = 12, 75%), ground-glass nodules (n = 9, 56.25%), consolidations (n = 7, 43.75%), "crazy-paving" pattern (n = 3, 18.75%), and interlobular septal thickening without ground-glass opacity (n = 3, 18.75%). Bilateral pleural effusion was an associated finding in 2 (12.5%) patients. Analysis of the axial distribution of the lesions revealed diffuse distribution in 11 (68.75%) patients and peripheral lung zone predominance in 5 (31.25%) patients. Abnormalities were bilateral in all 16 (100%) patients. Analysis of the craniocaudal distribution of the lesions revealed lower zone predominance in 9 (56.25%) patients, diffuse distribution in 5 (31.25%) patients, middle zone predominance in 1 (6.25%) patient, and upper zone predominance in 1 (6.25%) patient.
The most frequent HRCT findings in patients with leptospirosis causing DAH were ground-glass opacities, airspace nodules, ground-glass nodules, and consolidations. The lesions showed symmetrical distribution with lower zone predominance in most cases.