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Severe influenza A (H1N1): the course of imaging findings
Dorith Shaham1, Naama R Bogot, Galit Aviram
1Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. dshaham@hadassah.org.il
Background:
An outbreak of respiratory illness caused by a novel swine-origin influenza virus (influenza A/H1N1 2009) that began in Mexico was declared a global pandemic by the World Health Organization in June 2009. The pandemic affected many countries, including Israel.
Objectives:
To compare the course of chest radiographic and computed tomography findings in patients who survived and those who died following admission to the intensive care unit (ICU) or intubation due to severe laboratory-confirmed swine-origin influenza A/H1N1 2009.
Methods:
We retrospectively reviewed the patient records (267 radiographs, 8 CTs) of 22 patients (10 males, 12 females) aged 3.5-66 years (median 34) with confirmed influenza A/ H1N1 2009, admitted to the ICU and/or intubated in five major Israeli medical centers during the period July-November 2009. We recorded demographic, clinical, and imaging findings--including pattern of opacification, extent, laterality, distribution, zone of findings, and presence/absence of nodular opacities--at initial radiography and during the course of disease, and compared the findings of survivors and non-survivors. Statistical significance was calculated using the Wilcoxon (continuous variables) and Fisher exact tests.
Results:
The most common findings on the initial chest radiography were airspace opacities, which were multifocal in 17 patients (77%) and bilateral in 16 (73%), and located in the lower or lower and middle lung zones in 19 patients (86%). Large airspace nodules with indistinct margins were seen in 8 patients (36%). Twelve patients survived, 10 died. Patients who died had multiple background illnesses and were significantly older than survivors (P = 0.006). Radiologic findings for the two groups were not significantly different.
Conclusion:
Airspace opacities, often with nodular appearance, were the most common findings among patients with severe influenza A/H1N1 2009. The course of radiologic findings was similar in patients with severe influenza A/ H1N1 2009 who survived and those who died.
Insights
Severe swine-origin influenza A/H1N1 2009 presented common chest imaging findings like airspace opacities. Radiographic progression was similar in patients who survived and those who died from this novel influenza virus.
Area of Science:
- Infectious Diseases
- Radiology
- Critical Care Medicine
Background:
- The 2009 global pandemic of swine-origin influenza A/H1N1 virus significantly impacted numerous countries, including Israel.
- This novel influenza strain caused severe respiratory illness, necessitating intensive care and intubation for some patients.
Purpose of the Study:
- To compare chest radiographic and computed tomography (CT) findings between survivors and non-survivors of severe influenza A/H1N1 2009.
- To analyze the course of imaging findings in relation to patient outcomes (survival vs. death) in intensive care unit (ICU) settings.
Main Methods:
- Retrospective review of 22 patients with confirmed influenza A/H1N1 2009 admitted to ICUs in Israel.
- Analysis of 267 chest radiographs and 8 CT scans, recording demographic, clinical, and imaging characteristics.
- Comparison of imaging patterns and disease progression between survivors and non-survivors using statistical tests.
Main Results:
- The most frequent initial radiographic findings were multifocal and bilateral airspace opacities, predominantly in lower lung zones.
- Nodular opacities with indistinct margins were observed in 36% of patients.
- While non-survivors were older and had more comorbidities, initial and subsequent radiologic findings did not significantly differ between survivors and non-survivors.
Conclusions:
- Airspace opacities, sometimes with a nodular appearance, are characteristic imaging findings in severe influenza A/H1N1 2009.
- The progression of radiologic findings in severe influenza A/H1N1 2009 is similar in both patients who survive and those who succumb to the illness.
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