대한흉부영상의학회 Weekly Chest Cases

Case No : 967 Date 2016-05-09

Courtesy of Jae Wook Lee, Eun-Young Kang, Hwan Seok Yong / Korea University Guro Hospital
Age/Sex 58 / M
Chief ComplaintCough and fever for 7 days

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Diagnosis With Brief Discussion

Diagnosis: Influenza pneumonia (type A)
Radiologic Findings: Chest radiograph (Fig. 1) shows multifocal patchy opacities in both lung fields, predominantly in the subpleural location and lower lobes. HRCT (Fig. 2-4) obtained on the same day shows multifocal patchy ground-glass opacities along bronchovascular bundle and peripheral portions of both lungs with lower lobe predominance.
Influenza A was confirmed by multiplex real-time PCR performed on nasopharyngeal aspiration.
No other pathogen (neither viral nor bacterial) was verified from further studies.
The patient was treated with peramivir and the clinical symptoms and follow-up chest radiograph showed improvement.
Brief Review: Novel influenza A is an infectious pulmonary disease that appears to have originated in Mexico in April 2009. It has since spread rapidly to other parts of America, Europe, and Asia, with more than 503,536 cases reported worldwide. It has an associated morbidity and a reported worldwide mortality of about 1.2%.
Influenza virus belongs to the orthomyxovirus family of RNA viruses and human disease is predominantly caused by types A and B.
The clinical manifestations are varied and include flulike symptoms such as fever, cough, sore throat, body aches, headache, chills, and fatigue. In addition, nausea, vomiting, and/or diarrhea have been reported.
The predominant radiological pattern in influenza A pneumonia is bilateral ground glass opacities (GGO)and alveolar consolidation. The opacities are usually basal and in the midzones on the CXR while in the chest CT they are mainly peripheral and peribronchovascular with diffuse zonal involvement.
Chest CT is more helpful than CXR in diagnosing doubtful cases and in showing different patterns of opacities.
References: 1. 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;193:1488e93
2. S.S. Shim, Y. Kim, Y.J. Ryu. Novel influenza A (H1N1) infection: chest CT findings from 21 cases in Seoul, Korea. Clin Radiol, 66 (2011), pp. 118–124
3. Magdy et al. Radiological findings in patients with H1N1 influenza pneumonia. Egyptian Journal of Chest Diseases and Tuberculosis 2016; 65: 135-142
Keywords: Lung, Infection, Viral infection,

No. of Applicants : 116

▶ Correct Answer : 9/116, 7.8%

- Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
- Korea University Guro Hospital , Korea (South) Bit Na Park
- NEUROCITI DIAGNOSTICS , India Justin Moses
- Korea university medical center, guro hospital , Korea (South) LEE CHONG
- Korea university medical center, guro hospital , Korea (South) JINWOO HAN
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Korea University Guro Hospital , Korea (South) Jeong Woo Kim
- Private sector , Greece Vasilios Tzilas
- Korea University Guro Hospital , Korea (South) Yoonmi Choi

▶ Correct Answer as Differential Diagnosis : 8/116, 6.9%

- Northern Yokohama Showa university , Japan Kota Watanabe
- King Abdulaziz University Hospital , Saudi Arabia Amr Ajlan
- McGill University Health Center , Canada Alexandre Semionov
- Kyungpook national university hospital , Korea (South) Nari Jung
- Department of Radiology, Seoul National University Bundang Hospital , Korea (South) Sung Hyun Yoon
- Kyung Hee University Hospital at Gangdong , Korea (South) Han Na Lee
- Kyungpook national university hospital, Korea , Korea (South) Sung Jun Moon
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK

▶ Semi-Correct Answer : 7/116, 6.0%

- The University of Tokyo Hospital , Japan Akifumi Hagiwara
- Asan Medical Center , Korea (South) Hyung Jung Koo
- Hopital Bichat , France, Metropolitan Pauline Pradere
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- christian medical college , India mugil varman
- GHICL , France manuel toledano
- ICD,MCH CALICUT , India rikhy krishnan

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 967 Date 2016-05-09

Discussion

No. of Applicants : 116