Radiological features of Legionella Pneumophila Pneumonia Poster No.: E-0048 Congress: ESTI 2012 Type: Scientific Exhibit Authors: M. Vinciguerra, L. Stefanetti, E. Teti, G. Argentieri, L. G. 1 1 1 1 1 1 2 2 Vismara, C. De Dominicis ; Rome, RM/IT, Lugano, Ticino/CH Keywords: Lung, CT-High Resolution, Conventional radiography, Diagnostic procedure, Acute, Infection Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. www.myesr.org Page 1 of 11
Objectives The aim of this study is to describe radiological and CT findings of Legionella Pneumophila pneumonia. As intracellular agents, legionella pneumophilas are phagocytized by macrophages, in which they multiply, produce many proteins toxic to the host and finally, trought Kohn's pores, they damage the close alveoli. Materials and Methods This is a retrospective study of all patients admitted to our hospital with pneumonia due to Legionella pneumophila between 2007 and 2011. 23 patients were included, 18 males and 5 females, aged 30-78 years (median age 62 years). Diagnostic criteria included either a positive Legionella urinary antigen test and a chest radiograph consistent with pneumonia. All our cases were sporadic. HRCT was perfomed in 12 patients in the acute setting and after therapy. CT findings were analyzed considering: distribution and characteristics of opacities and pleural effusion. The distribution of parenchymal consolidation and ground-glass opacities (GGO), were subdivided into non segmental (lobar pneumonia) and segmental (bronchopneumonia) distributions. Results Consolidated areas with air bronchogram (n=23) or ground-glass opacities (n=7), associated or alone, were seen in all of the 23 cases (Fig. 1). CT scans showed segmental consolidation as the most common distribution pattern (87%) (Fig.2-3) with a non-segmental or lobar pattern in the other patients (13%) (Fig.4-5). In 12 cases (52%) bilateral distribution was described (Fig.6) and when a unilateral involvement was found (11 patients), the right lung (35%) was the most frequently involved (Fig.7). Pleural effusion was observed in 13 patients (57%) with right distribution (38%) (Fig.8), left distribution (16%) and bilateral distribution (46%). CT scan detected lymphadenopathy in 10 (43%) of the 23 cases. Images for this section: Page 2 of 11
Fig. 1: Coronal CT scan shows bilateral pneumonia with ground-glass opacities and concomitant consolidated areas. Page 3 of 11
Fig. 2: Sagittal CT scan shows typical segmental distribution in right upper and lower lobe. Page 4 of 11
Fig. 3: Typical segmental distribution with ground-glass opacities and consolidated areas. Page 5 of 11
Fig. 4: CT scan displays typical non segmental distribution in right upper lobe. Page 6 of 11
Fig. 5: Coronal CT scan displays typical non segmental involvement. Page 7 of 11
Fig. 6: Axial CT scan shows a bilateral pneumonia with typical non segmental distribution in right lower lobe and concomitant segmental distribution in left lung. Bilateral pleural effusion is also evident. Page 8 of 11
Fig. 7: X ray chest radiography shows multiple consolidated areas with air bronchogram of right lung. Page 9 of 11
Fig. 8: X ray chest radiography displays copious pleural effusion. Page 10 of 11
Conclusions Although there are not specific radiological findings, this study demonstrated that segmental distribution resulted more frequent than non-segmental distribution in Legionella pneumophila pneumonia; the incidence of bilateral or unilateral involvement was quite similar. Page 11 of 11