Image Findings of Patients with H1N1 Virus Pneumonia and Acute Respiratory Failure

ArticleinAcademic radiology 17(6):681-5 · June 2010with29 Reads
Impact Factor: 1.75 · DOI: 10.1016/j.acra.2010.03.013 · Source: PubMed

The aim of this study was to assess the findings of chest radiography and high-resolution computed tomography in patients requiring intensive care unit treatment for severe H1N1 virus pneumonia. In 2009, 10 patients required treatment in an intensive care unit for confirmed H1N1 pneumonia. All patients underwent chest radiography and high-resolution computed tomography. All 10 patients required mechanical ventilation because of respiratory failure. Nine patients presented with severe acute respiratory distress syndrome, and one patient died. Four patients underwent extracorporeal membrane oxygenation (ECMO) therapy. The results of chest radiography and high-resolution computed tomographic scans of these patients were systematically analyzed. The mean age of all patients was 44.1 +/- 12.3 years. All 10 patients showed abnormal results on chest radiography. The radiographic abnormalities were bilateral and multifocal in 10 patients. The predominant radiographic findings were consolidations (n = 9), ground-glass opacities (n = 8), and reticular opacities (n = 2). The most frequent computed tomographic findings at presentation consisted of bilateral ground-glass opacities (n = 9), pleural effusion (n = 9), areas of consolidation (n = 8), interstitial marking (n = 8), and crazy paving (n = 4). All patients undergoing ECMO therapy showed extensive bilateral ground-glass opacities, multifocal areas of consolidation, and crazy paving. Pleural effusion was present in three of four patients undergoing ECMO therapy. Patients requiring treatment in an intensive care unit for severe H1N1 pneumonia are at high risk for developing acute respiratory distress syndrome and frequently require ECMO therapy.

    • "Chest radiography is the first-line imaging technique for diagnosing lung disorders resulting in acute respiratory distress. Henzler et al described alveolar consolidations, ground-glass opacities, reticular opacities and pleural effusion as the most common findings in 10 patients with A/H1N1 infection [6]. Busi Rizzi et al report that the major radiological abnormalities were interstitial changes (60.0%), with (22.0%) or without patchy ground-glass appearance, and located in the lower lung zones (7.5%). "
    [Show abstract] [Hide abstract] ABSTRACT: ARDS is defined as an acute inflammatory syndrome characterized with bilateral parenchymal lung infiltrates on chest radiograph and PaO2/FiO2 ratio<200 resulting from causes other than acute left ventricular dysfunction. Inflammatory lung lesions may be induced by different disorders, with sepsis being the leading cause of ARDS. Other causes include infectious pneumonia, aspiration of gastric contents, drugs, severe trauma, fat embolism, surface burn, massive blood transfusion. Influenza A/H1N1 infection seems to be responsible for the development of extremely severe type of ARDS with poor response to routine treatment. Despite great progress in the management of ARDS with novel agents and sophisticated techniques, including antimicrobial drugs, extracorporeal membrane oxygenation, prostaglandins, nitric oxide, prostacyclin, exogenous surfactant administration and activated protein C, supportive treatment based mostly on advanced mechanical ventilation in the intensive care units seems to be the most important for the prognosis.
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    • "Consolidation is not a disease-specific pattern, and it may be seen in different kinds of lung diseases. It has recently been reported that consolidation is almost a common textural pattern in CT scans of patients with novel swine-origin H1N1 influenza616263646566. Consolidation is also a common pattern found in chest radiographs of patients with pneu- monia [67]. "
    Full-text · Dataset · Jun 2013
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    • "A crazy-paving pattern, in which ground-glass opacities are associated with septal thickening, has been reported in few cases in the literature.( 22 , 23 ) In our study, 15% of the patients showed this pattern. Septal thickening without ground-glass opacities was a mild secondary finding, being observed in only 4 patients (6%). "
    [Show abstract] [Hide abstract] ABSTRACT: To describe aspects found on HRCT scans of the chest in patients infected with the influenza A (H1N1) virus. We retrospectively analyzed the HRCT scans of 71 patients (38 females and 33 males) with H1N1 infection, confirmed through laboratory tests, between July and September of 2009. The HRCT scans were interpreted by two thoracic radiologists independently, and in case of disagreement, the decisions were made by consensus. The most common HRCT findings were ground-glass opacities (85%), consolidation (64%), or a combination of ground-glass opacities and consolidation (58%). Other findings were airspace nodules (25%), bronchial wall thickening (25%), interlobular septal thickening (21%), crazy-paving pattern (15%), perilobular pattern (3%), and air trapping (3%). The findings were frequently bilateral (89%), with a random distribution (68%). Pleural effusion, when observed, was typically minimal. No lymphadenopathy was identified. The most common findings were ground-glass opacities and consolidations, or a combination of both. Involvement was commonly bilateral with no axial or craniocaudal predominance in the distribution. Although the major tomographic findings in H1N1 infection are nonspecific, it is important to recognize such findings in order to include infection with the H1N1 virus in the differential diagnosis of respiratory symptoms.
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