Journal List > J Korean Soc Radiol > v.64(4) > 1086926

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Lee, Seon, Choi, Kim, Lim, Shin, Kim, and Park: High-resolution Computed Tomography Findings of H1N1 Influenza-Associated Pneumonia in Korea
Chest Radiology
Original Article

Journal of the Korean Society of Radiology 2011; 64(4): 351-359.

Published online: 30 April 2011

DOI: https://doi.org/10.3348/jksr.2011.64.4.351

High-resolution Computed Tomography Findings of H1N1 Influenza-Associated Pneumonia in Korea

Byung Chan Lee, M.D.2, Hyun Ju Seon, M.D.1, Song Choi, M.D.2, Jin Woong Kim, M.D.2, Hyo Soon Lim, M.D.2, Sang Soo Shin, M.D.1, Yun Hyeon Kim, M.D.1, Kyung Hwa Park, M.D.3

1Department of Radiology, Chonnam National University Hospital, Chonnam National University, Medical School, Korea.

2Department of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University, Medical School, Korea.

3Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University, Medical School, Korea.

Address reprint requests to: Hyun Ju Seon, M.D., Department of Radiology, Chonnam National University, School of Medicine, Chonnam University Hospital, 8 Hak-dong, Dong-gu, Gwangju 501-757, Korea. Tel. 82-62-220-5746, Fax. 82-62-226-4380, sunaura@hanmail.net

Received 24 November 2010       Accepted 18 January 2011

Copyright © 2011 The Korean Society of Radiology

Abstract

Purpose

To evaluate and compare the high-resolution computed tomography (HRCT) findings of patients with H1N1 influenza-associated pneumonia compared usual community acquired pneumonia (CAP), to determine whether there were any useful common HRCT findings predicting their prognosis.

Materials and Methods

HRCT findings of 31 patients (M:F = 16:15, mean age 42 yrs) with Influenza A (H1N1) infection were retrospectively reviewed for abnormal HRCT findings and compared to HRCT findings of CAP in matched patients. Patients were matched according to age and sex, from 2009 to January 2010.

Results

The predominant HRCT findings of pneumonia consisted of areas of consolidation and/or ground-glass opacity (GGO) which showed no statistically significant differences when comparing the two groups. However, the abnormalities of H1N1-related pneumonia showed higher bilaterality and multilobar or multisegmental involvement compared with CAP (p < 0.05). Internal low attenuation or air-densities in pulmonary infiltration/or lymphadenopathy was observed only in patients with CAP (p < 0.05). HRCT findings in 8 patients with poor clinical outcome had bilaterality (p=0.015), multilobar, and multisegmental involvement.

Conclusion

The predominant HRCT findings of H1N1-related pneumonia were areas of consolidation and/or GGO. In addition, H1N1-related pneumonia showed higher bilaterality or multilobar/multisegmental involvement compared with CAP. The patients who presented bilaterality had a worse clinical outcome.

Keywords: Tomography, X-Ray Computed, Influenza A Virus, H1N1 subtype, Pneumonia, Influenza, Human

Figures and Tables

Fig. 1

H1N1 influenza-associated pneumonia in a 31-year-old woman with fever. A chest HRCT scan shows subsegmental consolidation (black arrow) in right middle lobe and diffuse bronchial wall thickening (white arrow) in both lower lobes, and small centrilobular nodules with linear branching opacities (arrow heads) in right lower lobe.

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Fig. 2

HRCT patterns of abnormal parenchymal opacities in H1N1 associated pneumonia (black bar) and usual community acquired pneumonia (white bar) are consolidation, mixed pattern, or GGO. Each pattern of parenchymal opacities does not show statistically significant difference.

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Fig. 3

H1N1 influenza-associated pneumonia in a 51-year-old woman with cough. A chest HRCT scan shows multifocal consolidations (black arrow) with mild surrounding ground glass attenuation (arrowhead) in both lower lobes with posterior predominance.

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Fig. 4

H1N1 influenza-associated pneumonia in a 50-year-old woman with fever. An initial chest radiograph (A) shows multiple patchy areas of increased opacities in both lungs. Chest HRCT scan (B) shows multiple patchy areas of consolidations (open arrows in B) and ground glass attenuations (arrowhead in B) in both lungs.

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Fig. 5

Usual community acquired pneumonia in 79-year-old male with fever and general weakness. Chest CT scans (A-C) show consolidation in right lower lobe (open arrow in A) containing areas of mottled air densities (open arrow in B) and necrotic low attenuation (open arrow in C, postcontrast enhanced mediastinal window setting). Bilateral pleural (white arrows in B) and pericardial effusion (white arrowhead in B) are also noted.

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Table 1

Comparison of Radiologic Findings between the Patients with H1N1 Influenza Infection and the Patients with Usual Community Acquired Pneumonia (CAP), (n=31)

jksr-64-351-i001

Note.─ *8 of the 31 H1N1 infected patients didn't show zonal predominance.

31 patients who have CAP didn't show any zonal predominance.

Table 2

Characteristic Image Findings and Clinical Features in the Patients with H1N1 Influenza Infection Who Needed Mechanical Ventilation

jksr-64-351-i002

Note.─ *5 of 8 patients with mechanical ventilation therapy were died.

Table 3

Characteristic Image Findings in the Patients with H1N1 Influenza Infection Who Have Superimposed Other Bacterial Infection

jksr-64-351-i003

References

1. Perez-Padilla R, de la 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.
2. Centers for disease control and prevention. Novel H1N1 flu: Background on the situation. [Internet]. Atlanta: The Association;updated 2009 May 25. Available from: http://www.Cdc.Gov/h1n1flu/background.Html.
3. WHO. Global alert and response: Pandemic (H1N1) 2009 : Update 100. [Internet]. Geneva: World health organization;cited 2011 Jan 31. Availabe from: http://www.who.int/csr/don/2010_05_14/en/.
4. WHO. Media centre: H1N1 in post-pandemic period [Internet]. Geneva: World health organization;cited 2011 Jan 31. Available from: Http://www.who.Int/mediacentre/news/statements/2010/h1n1_vpc_20100810/en/.
5. Kim EA, Lee KS, Primack SL, Yoon HK, Byun HS, Kim TS, et al. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics. 2002; 22:S137–S149.
6. Agarwal PP, Cinti S, Kazerooni EA. Chest radiographic and CT findings in novel swine-origin influenza A (H1N1) virus (S-OIV) infection. AJR Am J Roentgenol. 2009; 193:1488–1493.
7. Ajlan AM, Quiney B, Nicolaou S, Muller NL. Swine-origin influenza A (H1N1) viral infection: radiographic and CT findings. AJR Am J Roentgenol. 2009; 193:1494–1499.
8. Lee EY, McAdam AJ, Chaudry G, Fishman MP, Zurakowski D, Boiselle PM. Swine-origin influenza A (H1N1) viral infection in children: initial chest radiographic findings. Radiology. 2010; 254:934–941.
9. Mollura DJ, Asnis DS, Crupi RS, Conetta R, Feigin DS, Bray M, et al. Imaging findings in a fatal case of pandemic swine-origin influenza A (H1N1). AJR Am J Roentgenol. 2009; 193:1500–1503.
10. Tanaka N, Matsumoto T, Kuramitsu T, Nakaki H, Ito K, Uchisako H, et al. High resolution CT findings in community-acquired pneumonia. J Comput Assist Tomogr. 1996; 20:600–608.
11. WHO. CDC protocol of realtime rtpcr for influenza A (H1N1) 2009. [Internet]. Genova: World health organization;update 2009 Apr 30. Available from: http://www.who.int/csr/resources/publications/swineflu/realtimeptpcr/en/.
12. Ramsdell J, Narsavage GL, Fink JB. Management of communityacquired pneumonia in the home: an american college of chest physicians clinical position statement. Chest. 2005; 127:1752–1763.
13. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner society: glossary of terms for thoracic imaging. Radiology. 2008; 246:697–722.
14. Elicker BM, Schwartz BS, Liu C, Chen EC, Miller SA, Chiu CY, et al. Thoracic CT findings of novel influenza A (H1N1) infection in immunocompromised patients. Emerg Radiol. 2010; 17:299–307.
15. Li P, Su DJ, Zhang JF, Xia XD, Sui H, Zhao DH. Pneumonia in novel swine-origin influenza A (H1N1) virus infection: high-resolution CT findings. Eur J Radiol. 2010; Forthcoming.
16. Soto-Abraham MV, Soriano-Rosas J, Diaz-Quinonez A, Silva-Pereyra J, Vazquez-Hernandez P, Torres-Lopez O, et al. Pathological changes associated with the 2009 H1N1 virus. N Engl J Med. 2009; 361:2001–2003.
17. Jain S, Kamimoto L, Bramley AM, Schmitz AM, Benoit SR, Louie J, et al. Hospitalized patients with 2009 H1N1 influenza in the united states, april-june 2009. N Engl J Med. 2009; 361:1935–1944.
18. Pittet LA, Hall-Stoodley L, Rutkowski MR, Harmsen AG. Influenza virus infection decreases tracheal mucociliary velocity and clearance of streptococcus pneumoniae. Am J Respir Cell Mol Biol. 2010; 42:450–460.
19. Dominguez-Cherit G, Lapinsky SE, Macias AE, Pinto R, Espinosa-Perez L, de la Torre A, et al. Critically ill patients with 2009 influenza A (H1N1) in mexico. JAMA. 2009; 302:1880–1887.
20. Aviram G, Bar-Shai A, Sosna J, Rogowski O, Rosen G, Weinstein I, et al. H1N1 influenza: initial chest radiographic findings in helping predict patient outcome. Radiology. 2010; 255:252–259.
21. Guo HH, Sweeney RT, Regula D, Leung AN. Best cases from the afip: fatal 2009 influenza A (H1N1) infection, complicated by acute respiratory distress syndrome and pulmonary interstitial emphysema. Radiographics. 2010; 30:327–333.
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