Round atelectasis as a complication of Legionnella pneumonia

Our plain-English summary of Round atelectasis as a complication of Legionnella pneumonia, by R. Kuno, D.J. Bower, S.M. Aguayo (Chest, 1994).

The study

• Authors: R. Kuno, D.J. Bower, S.M. Aguayo
• Journal: Chest
• Published: 1994;106(2):607-8
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Round atelectasis is a rare lung pseudotumor that is most commonly associated with asbestos-related pleural disease but can result from a variety of chronic pleural diseases. We describe a patient who developed round atelectasis over a period of only several months following an acute pleuropulmonary illness caused by Legionnella pneumophila.

In plain English

This was a case report of one patient. The authors noted that round atelectasis, a rare mass-like area of folded, collapsed lung, is most often linked to asbestos-related pleural disease. This patient, a 55-year-old man, had no history of asbestos exposure or smoking. Two years before referral, the patient had a sudden illness with fever, breathlessness, severe right-sided chest pain and coughing up blood. Small fluid collections were seen around both lungs, and sputum tested positive for Legionella pneumophila. Symptoms resolved with erythromycin. Five months later, right-sided chest pain returned, and over the next 6 months chest X-rays showed worsening pleural and lung changes. A thin-section CT scan of a right middle lobe nodule showed changes consistent with round atelectasis. Biopsy samples were unremarkable or showed only inflammation and collagen tissue, so surgery was judged unnecessary. The findings stayed stable at follow-up. The authors believed the Legionella infection inflamed the pleura and triggered the round atelectasis. They concluded that recognizing round atelectasis may prevent unnecessary chest surgery.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 55-year-old man referred for evaluation of a right middle lobe nodule seen on chest CT; no history of tobacco use or asbestos exposure
• Exposure: acute pneumonia with pleurisy caused by Legionella pneumophila; the patient had no history of asbestos exposure, although the authors note that round atelectasis is most commonly associated with asbestos-related pleural disease
• Main results:
  • At the initial illness, 2 years before referral, the patient had dyspnea, fever, severe right-sided chest pain and hemoptysis, with small bilateral effusions. Sputum was positive for Legionella pneumophila by direct fluorescent stain. The patient was treated with erythromycin and all symptoms resolved.
  • Five months later the patient had mild right-sided chest pain. Over the next 6 months, serial chest radiographs showed progressive pleuroparenchymal disease. Decubitus radiographs showed no pleural effusion.
  • Thin-section CT of a peripheral right middle lobe nodule showed changes consistent with round atelectasis.
  • Bronchoalveolar lavage and transbronchial biopsy specimens were unremarkable. A CT-guided needle biopsy showed only inflammation and acellular collagenous tissue. Thoracotomy was judged unnecessary.
  • The findings suggestive of round atelectasis appeared on CT about 2 years after the initial presentation, when initially there had been only minimal pleural abnormality.
  • The patient continued to do well at follow-up after the CT-guided biopsy, and the radiographic abnormalities remained stable. The scanned text prints the follow-up interval as 'IS months'.
• The authors' conclusion: The authors believed that Legionella pneumophila was the instigating insult that caused inflammation of the pleura and the development of round atelectasis. They stated, to their knowledge, that this was the first description of round atelectasis as a complication of a bacterial process. They concluded that suspecting and identifying round atelectasis may prevent unnecessary thoracotomies.

Topics

Medical terms in this study, explained in our Lexicon: Atelectasis, Asbestos-Related Pleural Disease.

Related studies

• Causative factors, imaging findings, and CT course of round atelectasis — L. Azour, T. Billah, et al. (2018)
• Round atelectasis and Metsovo lung — S.A. Papiris, M.A. Maniati, et al. (1993)
• Rounded atelectasis complicated by obstructive pneumonia and pulmonary arterial thrombosis — C.H. Chen, L. Newman (1990)
• Increased mortality from infectious pneumonia after occupational exposure to inorganic dust, metal fumes and chemicals — K. Torén, I. Qvarfordt, et al. (2011)
• Rounded atelectasis. Clinical experience with 74 patients — G. Hillerdal (1989)
• Rounded atelectasis of the lung — G.T. Stathopoulos, M.T. Karamessini, et al. (2005)

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