Chest Radiographic and CT Findings in Novel Swine-Origin Influenza A (H1N1) Virus (S-OIV) Infection
Chest Radiographic and CT Findings in Novel Swine-Origin Influenza A (H1N1) Virus (S-OIV) Infection
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DOI：
10.2214/ajr.09.3599
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发表时间：
2009-12-01
影响因子：
5
通讯作者：
Kazerooni, Ella A.
中科院分区：
文献类型：
--
作者：
Agarwal, Prachi P.;Cinti, Sandro;Kazerooni, Ella A.
OBJECTIVE.本文综述了在假定/实验室证实的新型猪源性甲型H1N1流感病毒（S-OIV）感染患者的胸部X线和CT表现。在2009年5月至2009年7月观察到的222例新型S-OIV（H1N1）感染患者中，66例（30%）接受胸部X线检查的患者构成了研究人群。第1组患者（n = 14）需要ICU住院和高级机械通气，第2组（n = 52）不需要。评价了初始X线片的异常模式（实变、磨玻璃样、结节和网状）、分布和程度。对胸部CT扫描（n = 15）进行了审查，以确定相同的结果和使用IV造影剂进行的肺栓塞（PE）。第1组患者主要为男性，平均年龄较高（43.5岁，第2组为22.1岁; p < 0.001）。66例受试者中有28例（42%）的初始X线片异常。主要影像学表现为斑片状实变（14/28; 50%），最常见于下肺区（20/28; 71%）和中央肺区（20/28; 71%）。所有第1组患者的初始X线片均异常;在第2组中，93%（13/14）与9.6%（5/52）观察到累及≥ 3个肺区的广泛疾病（p < 0.001）。第2组患者在初次X线片上没有> 20%的总体肺受累，而第1组患者为93%（13/14）。第1组患者中5/14例（36%）在CT上看到PE。超过一半的S-OIV（H1N1）患者的胸片正常，病情严重的患者进展为双侧广泛的气腔疾病，这些患者具有PE的高风险。
OBJECTIVE. This article reviews the chest radiographic and CT findings in patients with presumed/laboratory-confirmed novel swine-origin influenza A (H1N1) virus (S-OIV) infection.MATERIALS AND METHODS. Of 222 patients with novel S-OIV (H1N1) infection seen from May 2009 to July 2009, 66 patients (30%) who underwent chest radiographs formed the study population. Group 1 patients (n = 14) required ICU admission and advanced mechanical ventilation, and group 2 (n = 52) did not. The initial radiographs were evaluated for the pattern (consolidation, ground-glass, nodules, and reticulation), distribution, and extent of abnormality. Chest CT scans (n = 15) were reviewed for the same findings and for pulmonary embolism (PE) when performed using IV contrast medium.RESULTS. Group 1 patients were predominantly male with a higher mean age (43.5 years versus 22.1 years in group 2; p < 0.001). The initial radiograph was abnormal in 28 of 66 (42%) subjects. The predominant radiographic finding was patchy consolidation (14/28; 50%) most commonly in the lower (20/28; 71%) and central lung zones (20/28; 71%). All group 1 patients had abnormal initial radiographs; extensive disease involving = 3 lung zones was seen in 93% (13/14) versus 9.6% (5/52) in group 2 (p < 0.001). No group 2 patients had > 20% overall lung involvement on initial radiographs compared with 93% of group 1 patients (13/14). PEs were seen on CT in 5/14 (36%) of group 1 patients.CONCLUSION. Chest radiographs are normal in more than half of patients with S-OIV (H1N1) and progress to bilateral extensive air-space disease in severely ill patients, who are at a high risk for PE.