Proceedings of the British Thoracic Society
Journal: Thorax (1984)

We have compared the chest radiographs (CXR) of 49 consecutive adults seen with sporadic community acquired Legionnaires' disease pneumonia (LD) with those of 147 adults with other forms of community acquired pneumonia.These included 91 with pneumococcal pneumonia (PNP), (31 with pneumococcal bacteraemia/antigenaemia (bacT/Ag) and 46 with mycoplasma pneumonia (MP).On presentation, CXR shadowing was mainly homogeneous in 807o of LD cases and multilobe involvement was seen in 407o -a pattern similar to the other bacterial pneumonias.Radiographic deterioration after admission was commoner with LD (65%) and bact/Ag PNP (520o) than with non bact/Ag PNP (25%) and MP (25%).Spread to the opposite lung was a feature particularly of LD and bact/Ag PNP pneumonia.Segmental or lobar collapse was seen with all types of pneumonia and occurred at some stage in 37% LD cases.Pulmonary cavitation occurred in I patient with LD and in 4 patients with PNP.Hilar lymphadenopathy was identified in MP (22%) cases only.Pleural fluid was detected on the radiographs of 12 LD cases.Rate of radiographic resolution was examined for 161 survivors.Pulmonary shadows cleared particularly slowly following LD and bact/Ag PNP.Only 600/o cases had cleared by 12 weeks and 12% LD radiographs were still not clear at 20 weeks.CXR clearance following MP was much faster.Non bact/Ag PNP improved at an intermediate rate.Subsequently, linear streaky opacities were still seen in 29%o Ld and 26%7o bact/Ag PNP radiographs, suggesting that healing may be associated with fibrosis.We conclude that there are no unique radiographic features of different forms of sporadic community acquired pneumonia.Suppurative lung disease: a manageable complication of inflammatory bowel disease (IBD) G.S. BASRAN, J.T. MACFARLANE, D. DAVIES Four cases of rapidly progressive suppurative lung disease (SLD) are described in patients with pre-existing IBD (Crohn's or ulcerative colitis (UC)).In 3 cases SLD followed colectomy.The cardinal features were cough productive of large volumes of purulent phlegm (normal respiratory flora on culture) which was resistant to repeated courses of antibiotics.This was accompanied by increasing dyspnoea and increased linear basal markings on CXR.Bronchoscopy on Case I showed inflamed bronchial mucosa and intraluminal pus and bronchial histology and showed chronic inflammation with apthous ulcers rather similar to the colonic biopsy.Case I Case 2 Case 3 Case 4 Sex F F F M Bowel disease -type Crohn's UC UC Crohn's -age of onset 60 36 69 55 -colectomy Yes No Yes Yes SLD -age of onset 66 57 70 55 -symptoms before prednisolone days/month with cough 28 28 28 28 days/month with phlegm 28 28 28 28 -symptoms on prednisolone days/month with cough 0 4 0 28 days/month with phlegm 0 0 0 28In the 3 post-menopausal women but not the man, SLD improved dramatically on prednisolone (25 mg.daily).The response was shown as a reduction in the symptom score (table) and improvement in lung function (FEV1/FVC and daily PEFR).A maintenance dose of up to 5 mg.daily of prednisolone was titrated against the symptoms.This report should remind the physician of this subgroup of steroid-responsive SLD associated with active or inactive IBD.Diffuse asbestos-related pleural thickening: disability and lung function abnormalities C.R. McGAVIN, G. SHEERS A retrospecitve survey of records of men working in the Devonport Naval Dockyard has been carried out in order to assess disability arising from diffuse asbestos-related pleural thickening (DARPT).Thirty seven men were identified who had DARPT but no physiological evidence of airways obstruction and no definite radiographic evidence of asbestosis (profusion score for small irregular opacities <1/1 by the ILO classification).Breathlessness grade, lung function data, dust-exposure rating and a simple X-ray score were compared.Fifteen men were in M.R.C. breathlessness grades 3, 4 and 5. Men with higher (worse) X-ray scores had significantly lower vital capacities and were significantly more breathlessness than those with lower X-ray scores.Vital capacity was significantly lower in men with higher breathlessness grades.Transfer coefficient (Kco) was significantly raised in men with higher X-ray scores.There was no correlation between dust exposure rating and either 216 on July 16,