Middle East respiratory syndrome coronavirus infection CT: Difference between revisions

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==Overview==
==Overview==
Despite the increasing number of publications on [[MERS]] [[infection]], the description of [[chest]] [[CT|CT image]] findings is scarce. According to a study in which patients with laboratory-confirmed [[MERS]] [[infection]] underwent [[chest]] [[CT scanning]], the most prevalent findings were bilateral airspace abnormalities, predominantly located at the [[Base of lung|
On chest CT-scan, patients with MERS-CoV may demonstrate changes similar to patients with [[ARDS]]. CT scan may demonstrate bilateral airspace abnormalities with ground glass opacities, predominantly located at the bases of the lungs, suggestive of organizing [[pneumonia]].<ref name="AjlanAhyad2014">{{cite journal|last1=Ajlan|first1=Amr M.|last2=Ahyad|first2=Rayan A.|last3=Jamjoom|first3=Lamia Ghazi|last4=Alharthy|first4=Ahmed|last5=Madani|first5=Tariq A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings|journal=American Journal of Roentgenology|year=2014|pages=1–6|issn=0361-803X|doi=10.2214/AJR.14.13021}}</ref>
bases of the lungs]] essentially [[pleura|subpleural]] and characteristically consistent with ground-glass opacities, suggesting a pattern of organizing [[pneumonia]]. Attending to the broad range of [[symptoms]] and the different stages evolution of [[infection]], understanding early patterns of [[CT|CT images]], particularly in patients related to [[endemic|endemic areas]], might help in the early [[diagnosis]] of the condition.<ref name="AjlanAhyad2014">{{cite journal|last1=Ajlan|first1=Amr M.|last2=Ahyad|first2=Rayan A.|last3=Jamjoom|first3=Lamia Ghazi|last4=Alharthy|first4=Ahmed|last5=Madani|first5=Tariq A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings|journal=American Journal of Roentgenology|year=2014|pages=1–6|issn=0361-803X|doi=10.2214/AJR.14.13021}}</ref>


==CT==
==CT==
In [[MERS]] patients, [[chest]] [[CT|CT images]] have shown extensive bilateral patchy opacities. In critically ill patients, [[CT|CT image]] findings were noticed to be compatible with the ones from [[ARDS]] patients.<ref name="AjlanAhyad2014">{{cite journal|last1=Ajlan|first1=Amr M.|last2=Ahyad|first2=Rayan A.|last3=Jamjoom|first3=Lamia Ghazi|last4=Alharthy|first4=Ahmed|last5=Madani|first5=Tariq A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings|journal=American Journal of Roentgenology|year=2014|pages=1–6|issn=0361-803X|doi=10.2214/AJR.14.13021}}</ref><ref name="AssiriAl-Tawfiq2013">{{cite journal|last1=Assiri|first1=Abdullah|last2=Al-Tawfiq|first2=Jaffar A|last3=Al-Rabeeah|first3=Abdullah A|last4=Al-Rabiah|first4=Fahad A|last5=Al-Hajjar|first5=Sami|last6=Al-Barrak|first6=Ali|last7=Flemban|first7=Hesham|last8=Al-Nassir|first8=Wafa N|last9=Balkhy|first9=Hanan H|last10=Al-Hakeem|first10=Rafat F|last11=Makhdoom|first11=Hatem Q|last12=Zumla|first12=Alimuddin I|last13=Memish|first13=Ziad A|title=Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study|journal=The Lancet Infectious Diseases|volume=13|issue=9|year=2013|pages=752–761|issn=14733099|doi=10.1016/S1473-3099(13)70204-4}}</ref><ref name="ArabiArifi2014">{{cite journal|last1=Arabi|first1=Yaseen M.|last2=Arifi|first2=Ahmed A.|last3=Balkhy|first3=Hanan H.|last4=Najm|first4=Hani|last5=Aldawood|first5=Abdulaziz S.|last6=Ghabashi|first6=Alaa|last7=Hawa|first7=Hassan|last8=Alothman|first8=Adel|last9=Khaldi|first9=Abdulaziz|last10=Al Raiy|first10=Basel|title=Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus Infection|journal=Annals of Internal Medicine|volume=160|issue=6|year=2014|pages=389-397|issn=0003-4819|doi=10.7326/M13-2486}}</ref><ref name="pmid24224590">{{cite journal| author=Kligerman SJ, Franks TJ, Galvin JR| title=From the radiologic pathology archives: organization and fibrosis as a response to lung injury in diffuse alveolar damage, organizing pneumonia, and acute fibrinous and organizing pneumonia. | journal=Radiographics | year= 2013 | volume= 33 | issue= 7 | pages= 1951-75 | pmid=24224590 | doi=10.1148/rg.337130057 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24224590  }} </ref>
Chest CT abnormalities among patients with MERS-CoV may include any of the following:
 
*Extensive bilateral patchy opacities, predominantly in the lung bases and in the subpleural regions<ref name="AjlanAhyad2014">{{cite journal|last1=Ajlan|first1=Amr M.|last2=Ahyad|first2=Rayan A.|last3=Jamjoom|first3=Lamia Ghazi|last4=Alharthy|first4=Ahmed|last5=Madani|first5=Tariq A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings|journal=American Journal of Roentgenology|year=2014|pages=1–6|issn=0361-803X|doi=10.2214/AJR.14.13021}}</ref><ref name="pmid15229349">{{cite journal| author=Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM| title=Organizing pneumonia: perilobular pattern at thin-section CT. | journal=Radiology | year= 2004 | volume= 232 | issue= 3 | pages= 757-61 | pmid=15229349 | doi=10.1148/radiol.2323031059 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15229349  }} </ref><ref name="TravisCostabel2013">{{cite journal|last1=Travis|first1=William D.|last2=Costabel|first2=Ulrich|last3=Hansell|first3=David M.|last4=King|first4=Talmadge E.|last5=Lynch|first5=David A.|last6=Nicholson|first6=Andrew G.|last7=Ryerson|first7=Christopher J.|last8=Ryu|first8=Jay H.|last9=Selman|first9=Moisés|last10=Wells|first10=Athol U.|last11=Behr|first11=Jurgen|last12=Bouros|first12=Demosthenes|last13=Brown|first13=Kevin K.|last14=Colby|first14=Thomas V.|last15=Collard|first15=Harold R.|last16=Cordeiro|first16=Carlos Robalo|last17=Cottin|first17=Vincent|last18=Crestani|first18=Bruno|last19=Drent|first19=Marjolein|last20=Dudden|first20=Rosalind F.|last21=Egan|first21=Jim|last22=Flaherty|first22=Kevin|last23=Hogaboam|first23=Cory|last24=Inoue|first24=Yoshikazu|last25=Johkoh|first25=Takeshi|last26=Kim|first26=Dong Soon|last27=Kitaichi|first27=Masanori|last28=Loyd|first28=James|last29=Martinez|first29=Fernando J.|last30=Myers|first30=Jeffrey|last31=Protzko|first31=Shandra|last32=Raghu|first32=Ganesh|last33=Richeldi|first33=Luca|last34=Sverzellati|first34=Nicola|last35=Swigris|first35=Jeffrey|last36=Valeyre|first36=Dominique|title=An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias|journal=American Journal of Respiratory and Critical Care Medicine|volume=188|issue=6|year=2013|pages=733–748|issn=1073-449X|doi=10.1164/rccm.201308-1483ST}}</ref>
A study from ''Ajlan et al.'' has examined [[chest]] [[CT|CT images]] of patients with laboratory-confirmed [[MERS]] [[infection]], in order the identify [[lung]] abnormalities in this condition, so that an earlier [[diagnosis]], based on [[CT|CT images]], might be available. According to this study, the following observations were made:<ref name="AjlanAhyad2014">{{cite journal|last1=Ajlan|first1=Amr M.|last2=Ahyad|first2=Rayan A.|last3=Jamjoom|first3=Lamia Ghazi|last4=Alharthy|first4=Ahmed|last5=Madani|first5=Tariq A.|title=Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings|journal=American Journal of Roentgenology|year=2014|pages=1–6|issn=0361-803X|doi=10.2214/AJR.14.13021}}</ref>
*[[Pleural effusions]]
*[[CT|CT images]] of hospitalized patients [[infected]] with [[MERS-CoV]] commonly display airspace opacities, of which there is a predominance of [[Ground glass opacification on CT|ground-glass opacities]], when compared to consolidation. According to other previous studies, the degree of these opacities may vary among patients and according to the level of evolution of the [[disease]]. Additionally, it was also noted that these airspace opacities tend to be predominantly located at the [[base of the lung]] and in the [[pleura|subpleural]] region, which have been described as being compatible with the pattern of organizing [[pneumonia]].<ref name="pmid15229349">{{cite journal| author=Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM| title=Organizing pneumonia: perilobular pattern at thin-section CT. | journal=Radiology | year= 2004 | volume= 232 | issue= 3 | pages= 757-61 | pmid=15229349 | doi=10.1148/radiol.2323031059 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15229349  }} </ref><ref name="TravisCostabel2013">{{cite journal|last1=Travis|first1=William D.|last2=Costabel|first2=Ulrich|last3=Hansell|first3=David M.|last4=King|first4=Talmadge E.|last5=Lynch|first5=David A.|last6=Nicholson|first6=Andrew G.|last7=Ryerson|first7=Christopher J.|last8=Ryu|first8=Jay H.|last9=Selman|first9=Moisés|last10=Wells|first10=Athol U.|last11=Behr|first11=Jurgen|last12=Bouros|first12=Demosthenes|last13=Brown|first13=Kevin K.|last14=Colby|first14=Thomas V.|last15=Collard|first15=Harold R.|last16=Cordeiro|first16=Carlos Robalo|last17=Cottin|first17=Vincent|last18=Crestani|first18=Bruno|last19=Drent|first19=Marjolein|last20=Dudden|first20=Rosalind F.|last21=Egan|first21=Jim|last22=Flaherty|first22=Kevin|last23=Hogaboam|first23=Cory|last24=Inoue|first24=Yoshikazu|last25=Johkoh|first25=Takeshi|last26=Kim|first26=Dong Soon|last27=Kitaichi|first27=Masanori|last28=Loyd|first28=James|last29=Martinez|first29=Fernando J.|last30=Myers|first30=Jeffrey|last31=Protzko|first31=Shandra|last32=Raghu|first32=Ganesh|last33=Richeldi|first33=Luca|last34=Sverzellati|first34=Nicola|last35=Swigris|first35=Jeffrey|last36=Valeyre|first36=Dominique|title=An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias|journal=American Journal of Respiratory and Critical Care Medicine|volume=188|issue=6|year=2013|pages=733–748|issn=1073-449X|doi=10.1164/rccm.201308-1483ST}}</ref>
*[[septal]] thickening
*Some patients may display [[pleural effusions]] and [[septal]] thickening.
*Peribronchovascular involvement
*In this group of patients, there was no evidence of: [[cavitation]], [[Tree in bud|tree-in-bud pattern]] or [[lymph node]] enlargement.
*Traction [[bronchiectasis]] and reticulation
*A group of patients showed evidence of peribronchovascular involvement.
*Evidence of architectural distortion
*The [[CT]] pattern of the above lesions, displayed by [[MERS-CoV]] [[infected]] patients, was similar to the lesion pattern described in ''[[Influenza A virus subtype H1N1|H1N1 influenza A]]'' [[infected]] patients.<ref name="pmid19933639">{{cite journal| author=Ajlan AM, Quiney B, Nicolaou S, Müller NL| title=Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings. | journal=AJR Am J Roentgenol | year= 2009 | volume= 193 | issue= 6 | pages= 1494-9 | pmid=19933639 | doi=10.2214/AJR.09.3625 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19933639  }} </ref><ref name="AjlanKhashoggi2010">{{cite journal|last1=Ajlan|first1=Amr M.|last2=Khashoggi|first2=Khalid|last3=Nicolaou|first3=Savvas|last4=Müller|first4=Nestor L.|title=CT Utilization in the Prospective Diagnosis of a Case of Swine-Origin Influenza A (H1N1) Viral Infection|journal=Journal of Radiology Case Reports|volume=4|issue=3|year=2010|issn=1943-0922|doi=10.3941/jrcr.v4i3.427}}</ref>
*Two patients, in which the time window between [[symptom]] onset and [[CT scan]] was longest, showed evidence of traction [[bronchiectasis]] and reticulation. The remaining patients however, showed evidence of architectural distortion and [[pleura|subpleural]] bands.
*The authors alert to the fact that the time, between [[symptom]] onset and when [[CT|CT images]] were taken, was variable which may affect the ability to establish connections between imaging findings and [[symptom]] duration.


==References==
==References==
{{reflist|2}}
{{reflist|2}}
[[category:disease]]


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Latest revision as of 18:04, 18 September 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

Overview

On chest CT-scan, patients with MERS-CoV may demonstrate changes similar to patients with ARDS. CT scan may demonstrate bilateral airspace abnormalities with ground glass opacities, predominantly located at the bases of the lungs, suggestive of organizing pneumonia.[1]

CT

Chest CT abnormalities among patients with MERS-CoV may include any of the following:

  • Extensive bilateral patchy opacities, predominantly in the lung bases and in the subpleural regions[1][2][3]
  • Pleural effusions
  • septal thickening
  • Peribronchovascular involvement
  • Traction bronchiectasis and reticulation
  • Evidence of architectural distortion

References

  1. ↑ 1.0 1.1 Ajlan, Amr M.; Ahyad, Rayan A.; Jamjoom, Lamia Ghazi; Alharthy, Ahmed; Madani, Tariq A. (2014). "Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection: Chest CT Findings". American Journal of Roentgenology: 1–6. doi:10.2214/AJR.14.13021. ISSN 0361-803X.
  2. ↑ Ujita M, Renzoni EA, Veeraraghavan S, Wells AU, Hansell DM (2004). "Organizing pneumonia: perilobular pattern at thin-section CT". Radiology. 232 (3): 757–61. doi:10.1148/radiol.2323031059. PMID 15229349.
  3. ↑ Travis, William D.; Costabel, Ulrich; Hansell, David M.; King, Talmadge E.; Lynch, David A.; Nicholson, Andrew G.; Ryerson, Christopher J.; Ryu, Jay H.; Selman, Moisés; Wells, Athol U.; Behr, Jurgen; Bouros, Demosthenes; Brown, Kevin K.; Colby, Thomas V.; Collard, Harold R.; Cordeiro, Carlos Robalo; Cottin, Vincent; Crestani, Bruno; Drent, Marjolein; Dudden, Rosalind F.; Egan, Jim; Flaherty, Kevin; Hogaboam, Cory; Inoue, Yoshikazu; Johkoh, Takeshi; Kim, Dong Soon; Kitaichi, Masanori; Loyd, James; Martinez, Fernando J.; Myers, Jeffrey; Protzko, Shandra; Raghu, Ganesh; Richeldi, Luca; Sverzellati, Nicola; Swigris, Jeffrey; Valeyre, Dominique (2013). "An Official American Thoracic Society/European Respiratory Society Statement: Update of the International Multidisciplinary Classification of the Idiopathic Interstitial Pneumonias". American Journal of Respiratory and Critical Care Medicine. 188 (6): 733–748. doi:10.1164/rccm.201308-1483ST. ISSN 1073-449X.
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