Early Radiographic and Tomographic Manifestations of Legionnaires' Disease

Legionnaires' disease (LD) may occur sporadically or in the course of outbreaks, where the typical radiological manifestations of the disease may better be delineated. We took advantage of a rare community-based epidemic of LD (181 patients) that occurred in 2012 in Quebec City, Canada, to describe the radiographic features of LD and compare the its tomographic presentation with that of community-acquired pneumonia caused by common bacteria other than Legionella pneumophila.

From the 181 individuals affected in the outbreak, we obtained the chest radiographs of 159 individuals (mean 63 ± 15 years of age) for detailed analysis; 33 patients had a computed tomography (CT) scan performed during the course of their illness. In a case-control study, we compared the CT scans of patients with LD with those of patients who had received a diagnosis of community-acquired pneumonia caused by a pathogen other than Legionella and confirmed by chest CT scan.

Overall, LD most often presented as an airspace consolidation involving 1 of the lower lobes. Pleural effusion and mediastinal adenopathies were apparent only in a minority, whereas no pneumothorax or cavitation was noted. We did not find any significant difference in chest CT scan findings in patients with LD vs those with community-acquired pneumonia from other bacterial origin. No radiological finding was clearly associated with an increased risk of intensive care unit admission or mortality.

The early radiographic and tomographic manifestations of LD are nonspecific and similar to those found in community-acquired pneumonia from other bacterial origin.