Im J G, Yeon K M, Han M C, Kim C W, Webb W R, Lee J S, Han Y C, Chang W H, Chi J G
Department of Radiology, College of Medicine, Seoul National University, Korea.
AJR Am J Roentgenol. 1989 May;152(5):955-9. doi: 10.2214/ajr.152.5.955.
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 seen in the guinea pigs.
钩端螺旋体病是由钩端螺旋体属的任何一组螺旋体引起的疾病。主要受累器官为肝脏、中枢神经系统、肾脏、骨骼肌和肺。58例经血清学阳性证实的钩端螺旋体病患者中，37例（64%）有肺部影像学表现。有三种影像学表现：（1）37例患者中有21例（57%）有小结节状密度影，（2）6例（16%）有大片融合性实变区，（3）10例（27%）有弥漫性、边界不清的磨玻璃密度影。系列胸片显示结节状表现之后有融合性实变和/或磨玻璃密度影的趋势。异常表现均为双侧性、非叶性，且明显倾向于外周为主。肺部异常在15天内消退，但有8例患者因呼吸衰竭（6例）或其他原因（2例）死亡。为了将病理与影像学表现相关联，将从一名患者分离出的钩端螺旋体经腹腔注射到20只豚鼠体内。所有豚鼠的肺均显示瘀点性出血，进而发展为大片融合性出血区。钩端螺旋体病典型的肺部影像学表现与豚鼠中所见的多灶性肺出血相符。
