【每日动态】中东呼吸综合征的CT多呈机化性肺炎表现
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In 7 patients hospitalized with Middle East Respiratory Syndrome coronavirus (MERS-CoV),the most common chest computed tomography (CT) findings are suggestive oforganizing pneumonia, according to a study byresearchers in Saudi Arabia, publishedonline June 18 in the American Journal of Roentgenology. AmJ Roentgenol. Published online June 18, 2014. Abstract"It is early at this stage to reachany solid conclusions, but our understanding of MERS-CoV may undergo the sameevolution as that of H1N1 influenza A virus," write Amr M. Ajlan, MD, fromthe Cardiothoracic Imaging Unit, Department of Radiology, King AbdulazizUniversity Hospital, King Abdulaziz University, Jeddah, Western Region, SaudiArabia, and colleagues.
Organizing pneumonia is a nonspecificinflammatory response in the lungs that has also been described in H1N1influenza A virus. The first reported case of MERS occurred in Saudi Arabia inSeptember 2012. Since then, other MERS cases have been identified in the MiddleEast, Europe, United States, North Africa, and the Philippines.
MERS has a high mortality rate. Althoughits source remains unknown, transmission of the virus has been linked tocamels, and travel to the Middle East seems to be a determining factor. Duringa review of electronic medical records, the researchers identified 7 patientshospitalized with MERS at King Abdulaziz University Hospital and King FaisalSpecialist Hospital in Jeddah, Saudi Arabia. They confirmed the presence ofMERS-CoV using reverse transcriptase polymerase chain reaction. Two trainedthoracic radiologists independently reviewed the CTs.
The patients' ages ranged from 19 to 83years, and their main symptoms included cough, fever, shortness of breath,increased sputum, abdominal pain, back pain, fatigue, and muscle pain. Onepatient had a history of contact with camels, and 1 patient was a physician whohad contact with several patients with MERS. The remaining 5 patients had nohistory of contact with other patients with MERS or with animals. Six patientsrequired mechanical ventilation, and 3 patients died.
The median time from hospital admission toCT imaging was 11 days. Five patients had ground-glass opacities andconsolidation. Five patients also had subpleural, mostly lower lung airspaceinvolvement, with 4 of these patients also having involvement of theperibronchovascular airspaces. Six patients had bilateral abnormalities. Threepatients had septal thickening, and 3 had small bilateral pleural effusions.
Limitations of the study included itsretrospective design, small number of patients, and variable time betweensymptom onset and CT imaging, which could hinder correlation of CT findingswith clinical symptoms and outcomes. In addition, diagnosis of MERS could becomplicated by mild or uncommon symptoms, undetected cases in carriers, andfalse-negative laboratory results.
The authors point out that interpreting CTfindings while awaiting laboratory results could help with early isolation andmanagement of MERS cases.
"[T]he most common CT finding inhospitalized patients with MERS-CoV infection is thatof bilateral predominantly subpleural and basilar airspace, with more extensiveground-glass opacities than consolidation," the authors conclude."The predilection of the abnormalities to the subpleural andperibronchovascular regions is suggestive of an organizing pneumonia pattern.Recognizing this pattern in acutely ill patients living in or traveling fromendemic areas may help in the early diagnosis of MERS-CoV infection."
Organizing pneumonia is a nonspecificinflammatory response in the lungs that has also been described in H1N1influenza A virus. The first reported case of MERS occurred in Saudi Arabia inSeptember 2012. Since then, other MERS cases have been identified in the MiddleEast, Europe, United States, North Africa, and the Philippines.
MERS has a high mortality rate. Althoughits source remains unknown, transmission of the virus has been linked tocamels, and travel to the Middle East seems to be a determining factor. Duringa review of electronic medical records, the researchers identified 7 patientshospitalized with MERS at King Abdulaziz University Hospital and King FaisalSpecialist Hospital in Jeddah, Saudi Arabia. They confirmed the presence ofMERS-CoV using reverse transcriptase polymerase chain reaction. Two trainedthoracic radiologists independently reviewed the CTs.
The patients' ages ranged from 19 to 83years, and their main symptoms included cough, fever, shortness of breath,increased sputum, abdominal pain, back pain, fatigue, and muscle pain. Onepatient had a history of contact with camels, and 1 patient was a physician whohad contact with several patients with MERS. The remaining 5 patients had nohistory of contact with other patients with MERS or with animals. Six patientsrequired mechanical ventilation, and 3 patients died.
The median time from hospital admission toCT imaging was 11 days. Five patients had ground-glass opacities andconsolidation. Five patients also had subpleural, mostly lower lung airspaceinvolvement, with 4 of these patients also having involvement of theperibronchovascular airspaces. Six patients had bilateral abnormalities. Threepatients had septal thickening, and 3 had small bilateral pleural effusions.
Limitations of the study included itsretrospective design, small number of patients, and variable time betweensymptom onset and CT imaging, which could hinder correlation of CT findingswith clinical symptoms and outcomes. In addition, diagnosis of MERS could becomplicated by mild or uncommon symptoms, undetected cases in carriers, andfalse-negative laboratory results.
The authors point out that interpreting CTfindings while awaiting laboratory results could help with early isolation andmanagement of MERS cases.
"[T]he most common CT finding inhospitalized patients with MERS-CoV infection is thatof bilateral predominantly subpleural and basilar airspace, with more extensiveground-glass opacities than consolidation," the authors conclude."The predilection of the abnormalities to the subpleural andperibronchovascular regions is suggestive of an organizing pneumonia pattern.Recognizing this pattern in acutely ill patients living in or traveling fromendemic areas may help in the early diagnosis of MERS-CoV infection."
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