Abstract
Purpose
We retrospectively analyzed the computed tomography (CT) findings of H1N1 virus infection in 17 patients with relatively mild illness.
Materials and methods
From September 2009 to January 2010, a total of 17 patients with confirmed H1N1 infection were included in the study (mean age 30.7 years). All patients were managed as outpatients or required short hospitalization without ventilation assistance. The CT scans were assessed for the presence of nodules, ground glass opacity (GGO), consolidation, bronchial wall thickening, reticulation, effusion, and lymph node enlargement. Location and distribution were evaluated.
Results
The most frequent manifestation was a mixture of nodules, consolidation, and GGO (5/17, 29.4%). In one case there was a focal area of bronchiolitis (centrilobular nodules with tree-in-bud appearance), and 10 of 17 cases (58.8%) showed bronchial wall thickening (findings of bronchitis/peribronchitis) and/or other abnormalities. In 16 of the 17 cases (94.1%) there were CT abnormalities with bilateral and random distribution without zonal predominance. Pleural effusions were seen in eight cases (47.1%).
Conclusion
In contrast to several reports so far, CT findings of H1N1 virus infection in patients with mild illness are variable, including suggestive findings of inflammation involving large and/or small airways. This study showed various CT findings overlapping with other viral, atypical, or bacterial pneumonia and even cryptogenic organizing pneumonia.
Key words: Chest CT, H1N1 virus, Swine-origin influenza A, Infectious disease
References
- 1.Libster R., Bugna J., Coviello S., Hijano D.R., Dunaiewsky M., Reynoso N., et al. Pediatric hospitalizations associated with 2009 pandemic influenza A (H1N1) in Argentina. N Engl J Med. 2010;362:45–55. doi: 10.1056/NEJMoa0907673. [DOI] [PubMed] [Google Scholar]
- 2.Chowell G., Bertozzi S.M., Colchero M.A., Lopez-Gatell H., Alpuche-Aranda C., Hernandez M., et al. Severe respiratory disease concurrent with the circulation of H1N1 influenza. N Engl J Med. 2009;361:674–679. doi: 10.1056/NEJMoa0904023. [DOI] [PubMed] [Google Scholar]
- 3.Perez-Padilla R., Rosa-Zamboni D., Ponce de leon S., Hernandez M., Quinones-Falconi F., Bautista E., et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009;361:680–689. doi: 10.1056/NEJMoa0904252. [DOI] [PubMed] [Google Scholar]
- 4.Lessler J., Nicholas G., Reich B.A., Derek A.T.C., New York City Department of HealthMental Hygiene Swine Influenza Investigation Team Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med. 2009;361:2628–2636. doi: 10.1056/NEJMoa0906089. [DOI] [PubMed] [Google Scholar]
- 5.Cao B., LI X.W., Mao Y., Wang J., Lu H.Z., Chen Y.S., et al. Clinical features of the initial cases of 2009 pandemic influenza A (H1N1) virus infection in China. N Engl J Med. 2009;361:2507–2517. doi: 10.1056/NEJMoa0906612. [DOI] [PubMed] [Google Scholar]
- 6.Agarwal P.P., Cinti S., Kazerooni E.A. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol. 2009;193:1488–1493. doi: 10.2214/AJR.09.3599. [DOI] [PubMed] [Google Scholar]
- 7.Ajlan A.M., Quiney B., Nicolaou S., Muller N.L. Swine-origin influenza A (H1N1) viral infection; radiographic and CT findings. AJR Am J Roentgenol. 2009;193:1494–1499. doi: 10.2214/AJR.09.3625. [DOI] [PubMed] [Google Scholar]
- 8.Mollura D.J., Asnis D.S., Crupi R.S., Conetta R., Feigin D.S., Bray M., et al. Imaging findings in a fatal case of pandemic swineorigin influenza A (H1N1) AJR Am J Roentgenol. 2009;193:1500–1503. doi: 10.2214/AJR.09.3365. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Lee C.W., Seo J.B., Song J.W., Lee J.S., Kim M.Y., Chae E.J., et al. Pulmonary complication of novel influenza A (H1N1) infection: imaging features in two patients. Korean J Radiol. 2009;10:531–534. doi: 10.3348/kjr.2009.10.6.531. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Abekka HA. X-rays and CT offer predictive power for swine flu diagnosis. Available at: www.diagnosticimaging.com/news/display/article/113619/1425699#. Published June 30, 2009. Accessed September 9, 2009.
- 11.Ketai L.H. Conventional wisdom: unconventional virus. AJR Am J Roentgenol. 2009;193:1486–1487. doi: 10.2214/AJR.09.3758. [DOI] [PubMed] [Google Scholar]
- 12.Kim S.J., Lee K.S., Ryu Y.H., Yoon Y.C., Choe K.O., Kim T.S., et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. AJR Am J Roentgenol. 2003;180:1251–1254. doi: 10.2214/ajr.180.5.1801251. [DOI] [PubMed] [Google Scholar]
- 13.Conte P., Heitzman E.R., Markarian B. Viral pneumonia, roentgen pathological correlations. Radiology. 1970;95:267–272. doi: 10.1148/95.2.267. [DOI] [PubMed] [Google Scholar]
- 14.Osborne D. Radiologic appearance of viral disease of the lower respiratory tract in infants and children. AJR Am J Roentgenol. 1978;13:29–33. doi: 10.2214/ajr.130.1.29. [DOI] [PubMed] [Google Scholar]
- 15.Han B.K., Son J.A., Yoon H.K., Lee S.I. Epidemic adenoviral lower respiratory tract infection in pediatric patients: radiographic and clinical characteristics. AJR Am J Roentgenol. 1998;170:1077–1080. doi: 10.2214/ajr.170.4.9530062. [DOI] [PubMed] [Google Scholar]
