Middle East respiratory syndrome coronavirus infection CT
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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
Despite the increasing number of publications on MERS infection, the description of chest 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 bases of the lungs essentially 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 images, particularly in patients related to endemic areas, might help in the early diagnosis of the condition.[1]
CT
In MERS patients, chest CT images have shown extensive bilateral patchy opacities. In critically ill patients, CT image findings were noticed to be compatible with the ones from ARDS patients.[1][2][3]
A study from Ajlan et al. has studied the chest 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 images, might be available. According to this study, the following observations were made:[1]
- CT images of hospitalized patients infected with MERS-CoV commonly display airspace opacities, of which there is a predominance of 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 sub pleural region, which has been described as being compatible with the pattern of organizing pneumonia.[4][5]
- Some patients may display pleural effusions and septal thickening.
- In this group of patients, there was no evidence of: cavitation, tree-in-bud pattern or lymph node enlargement.
- A group of patients showed evidence of peribronchovascular involvement.
- The CT pattern of the above lesions, displayed by MERS-CoV infected patients, was similar to the lesion pattern described in H1N1 influenza A infected patients.[6][7]
- 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 subpleural bands.
- The authors alert to the fact that the time, between symptom onset and when CT images were taken, was variable which may affect the ability to establish connections between imaging findings and symptom duration.
References
- ↑ 1.0 1.1 1.2 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.
- ↑ Assiri, Abdullah; Al-Tawfiq, Jaffar A; Al-Rabeeah, Abdullah A; Al-Rabiah, Fahad A; Al-Hajjar, Sami; Al-Barrak, Ali; Flemban, Hesham; Al-Nassir, Wafa N; Balkhy, Hanan H; Al-Hakeem, Rafat F; Makhdoom, Hatem Q; Zumla, Alimuddin I; Memish, Ziad A (2013). "Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia: a descriptive study". The Lancet Infectious Diseases. 13 (9): 752–761. doi:10.1016/S1473-3099(13)70204-4. ISSN 1473-3099.
- ↑ Arabi, Yaseen M.; Arifi, Ahmed A.; Balkhy, Hanan H.; Najm, Hani; Aldawood, Abdulaziz S.; Ghabashi, Alaa; Hawa, Hassan; Alothman, Adel; Khaldi, Abdulaziz; Al Raiy, Basel (2014). "Clinical Course and Outcomes of Critically Ill Patients With Middle East Respiratory Syndrome Coronavirus Infection". Annals of Internal Medicine. 160 (6): 389–397. doi:10.7326/M13-2486. ISSN 0003-4819.
- ↑ 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.
- ↑ 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.
- ↑ Ajlan AM, Quiney B, Nicolaou S, Müller NL (2009). "Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings". AJR Am J Roentgenol. 193 (6): 1494–9. doi:10.2214/AJR.09.3625. PMID 19933639.
- ↑ Ajlan, Amr M.; Khashoggi, Khalid; Nicolaou, Savvas; Müller, Nestor L. (2010). "CT Utilization in the Prospective Diagnosis of a Case of Swine-Origin Influenza A (H1N1) Viral Infection". Journal of Radiology Case Reports. 4 (3). doi:10.3941/jrcr.v4i3.427. ISSN 1943-0922.