Radiographic features of Legionnaires' disease

Serial chest radiographs of 35 patients with confirmed Legionnaires' disease were evaluated. A unilateral, unilobar alveolar infiltrate was, in general, the initial radiographic finding. Progression to consolidation or to new areas of involvement was typical. Every lobe was involved, but lower lobe involvement was most common. Pleural effusion was often present. Cavitation was not seen. Radiographic progression for several days following institution of therapy, and despite clinical response, was noted. In patients who survived, radiographic improvement of abnormalities was usually apparent within two weeks of therapy. Aradiographic spectrum exists and, although many features are typical, no single feature is pathognomonic.