Two cases of leptospirosis presenting with cough and haemoptysis are described, together with their pulmonary radiological features. The various radiological chest findings are reviewed together with the pathogenesis and pathology of the lesions. Although the pulmonary involvement due to a haemorrhagic pneumonitis in leptospirosis is usually an incidental finding, occasionally it is the most pronounced clinical manifestation of the disease, and may present a difficult diagnostic problem. It has to be considered in the differential diagnosis of diffuse miliary infiltrations or consolidation seen on the chest radiographs, especially in countries where both pulmonary tuberculosis and leptospirosis are not uncommon diseases.
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