What is the role of imaging studies in the diagnosis of Legionella infection?

Updated: Nov 13, 2018
  • Author: Mobeen H Rathore, MD, CPE, FAAP, FIDSA; Chief Editor: Russell W Steele, MD  more...
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  • Pneumonia is the predominant clinical syndrome of Legionnaires disease. Chest radiography findings vary and are nonspecific and indistinguishable from those observed with other pneumonias.

  • Although initial chest radiography findings may be normal, especially in patients with nosocomial disease, the usual progression of findings on serial studies is from patchy areas or nodular appearance to multilobar, almost homogeneous, infiltrates. [17, 28]

  • Unilateral involvement is more common than bilateral involvement. Purely interstitial infiltrates are rare. Pleural effusion, present in at least one third of patients, may be the only abnormality. In adults, cavitation is more common in patients who are immunocompromised but has been described both in immunocompromised and immunocompetent children. [29, 30, 31]

  • Radiographic findings usually progress despite appropriate antibiotic therapy; infiltrates may take as long as 4 months to completely resolve. Permanent bullous emphysema requiring lobectomy has been reported. [32]

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