Zika virus (ZIKV) is a mosquito-borne arbovirus from the Flaviviridae family. It had caused several epidemics since its discovery in 1947, but there was no significant attention to this virus until the recent outbreak in Brazil in 2015. The main concern is the causal relationship between prenatal ZIKV infection and congenital microcephaly, which has been confirmed recently. Moreover, ZIKV may cause other central nervous system abnormalities such as brain parenchymal atrophy with secondary ventriculomegaly, intracranial calcification, malformations of cortical development (such as polymicrogyria, and lissencephaly-pachygyria), agenesis/hypoplasia of the corpus callosum, cerebellar and brainstem hypoplasia, sensorineural hearing-loss, and ocular abnormalities as well as arthrogryposis in the infected fetuses. Postnatal (acquired) ZIKV infection usually has an asymptomatic or mildly symptomatic course, while prenatal (congenital) ZIKV infection has a more severe course and may cause severe brain anomalies that are described as congenital Zika syndrome. In this pictorial essay, we aim to illustrate the prenatal and postnatal neuroimaging findings that may be seen in fetuses and neonates with congenital Zika syndrome, and will discuss possible radiological differential diagnoses. A detailed knowledge of these findings is paramount for an early correct diagnosis, prognosis determination, and counseling of the affected children and families.
Since the description of cryptogenic organizing pneumonia in 1983 by Davison et al and the subsequent report on bronchiolitis obliterans organizing pneumonia by Epler et al, some reports have been published regarding the imaging features of organizing pneumonia (OP). In this pictorial review, we aimed to describe and illustrate different manifestations of OP on highresolution CT (HRCT) accompanied by their histopathological correlations for a better comprehension of pathomechanism of the radiological findings. The main HRCT findings in OP include: consolidation, ground-glass opacification, perilobular opacity, reversed halo opacity, nodule or mass, parenchymal bands, bronchial wall thickening, bronchial dilatation, mediastinal lymphadenopathy and pleural effusion. In addition, we discuss the radiological differential diagnosis for each manifestation, as well as imaging evolution during patient follow-up, and two OP-related entities: the possibility of non-specific interstitial pneumonia development following OP and a relatively new rare entity related to OP called acute fibrinous and organizing pneumonia. For radiologists and physicians, a detailed knowledge of the potential radiological manifestations in OP is crucial for making a correct diagnosis and managing the patient properly. Moreover, some unnecessary lung biopsies will be avoided.
Both modalities are extremely helpful for the diagnosis of penile fracture. Considering the cost-efficiency and accessibility of ultrasonography, US is recommended as the first-line tool for both diagnosis and preoperative mapping. MRI may be used as a complementary study in the patients for whom US fails to visualize or precisely define the tunica defect.
Zika virus (ZIKV) is a mosquito-borne arbovirus from the Flaviviridae family, first discovered in 1947. There has been no report of severe complications caused by this virus in humans until recently. However, it is confirmed now that prenatally acquired ZIKV infection may cause severe congenital brain abnormalities in the infected fetuses. In addition, there has been an increasing number of reports during recent years about the causal relationship between postnatally acquired ZIKV infection and severe neurologic complications (mostly immune-mediated ones). Hence, ZIKV should not be considered as benign as it was initially thought, but it might be seen as a serious global threat to human health that may severely affect not only fetuses. In this pictorial essay, we aim to describe and illustrate the currently recognized spectrum of neuroimaging findings in postnatally acquired ZIKV infection. Although neurologic complications do not frequently occur in postnatal ZIKV infection, it is important to be aware of them because they may cause high morbidity and mortality in the affected patients. In addition to clinical and laboratory findings, neuroimaging may help in the diagnostic work-up to make the correct diagnosis, determine the extent of the disease, and follow the clinical course.
Zika virus (ZIKV) is a mosquito-borne arbovirus from the family Flaviviridae, which had caused some epidemics since its discovery in 1947 without any significant impacts on public health. In 2015, however, a 20-fold increase in congenital microcephaly cases in northeastern Brazil was attributed to prenatally acquired ZIKV infection. Traditionally, TORCH agents have 4 common characteristics including causing a mild illness in infected mother, vertical transmission to fetus, developing several anomalies in the affected fetus, and in some instances, maternal therapy may not ameliorate fetal prognosis. Prenatal ZIKV infection has shown the aforementioned characteristics during the recent epidemics in South America and the Caribbean region; therefore, it should be considered as an emerging TORCH agent that may seriously threaten public health. Fetal ultrasound can be used as a safe, inexpensive, and easy-to-access imaging modality for detecting suspicious cases of congenital Zika syndrome in utero and suggesting confirmatory diagnostic examinations to these patients.
about 1-13% of pregnant women infected in the first trimester will have a child with microcephaly and other cerebral abnormalities [4]. These facts suggest that congenital ZIKV infection, which is vertically transmitted to the fetus from the infected mother, is much less benign than acquired infection. This issue has made congenital ZIKV infection a "Public Health Emergency of International Concern" (World Health Organization declaration, 1 February 2016).We agree with Prof. Wiwanitkit that neuroimaging findings are most likely normal in the majority of patients with acquired Zika infection. There are a few exceptions, including adult patients complicated by ZIKV-related Guillain-Barré syndrome (GBS), which may be associated with post-contrast enhancement of the cranial nerves, conus medullaris, cauda equina nerve roots, and lumbar spinal ganglia on magnetic resonance imaging (MRI) as well as adult patients with ZIKV-related acute disseminated encephalomyelitis (ADEM) exerting brain and spinal cord changes on MRI study. On the other hand, the majority of fetuses/neonates with congenital Zika infection have abnormal neuroimaging findings including microcephaly, intracranial calcifications, malformations of cortical development (mostly polymicrogyria), cerebellar and brainstem hypoplasia, ventriculomegaly, agenesis/ hypoplasia of the corpus callosum, absent cavum septum pellucidum, white matter changes most likely due to dysmyelination, and ocular abnormalities. These findings may be detected in the prenatal or neonatal imaging studies [2,3,5].In conclusion, when discussing neuroimaging findings in Zika virus infection, it is extremely important to differentiate between congenital and acquired infection. Our review article focused mainly on congenital ZIKV infection, which is associated with abnormal neuroimaging findings Dear Editor, We appreciate the interest on our article by Prof. Viroj Wiwanitkit [1]. We agree with Dr. Wiwanitkit that acquired Zika virus (ZIKV) infection is asymptomatic in up to 80% of the affected people, and it is estimated that only 20% of infected cases are symptomatic. Moreover, ZIKV causes a self-limited disease with fever, myalgia, arthralgia, maculopapular rash, and conjunctivitis in the majority of symptomatic adult patients. Our review article, however, focused mainly on neuroimaging findings of congenital ZIKV infection along with two autoimmune conditions that may complicate the acquired ZIKV infection [2].The outbreak of Zika virus infection in Brazil in 2015 was associated with an increase in the cases of congenital microcephaly by a factor of 20. The suspected causal relationship between prenatal ZIKV infection and microcephaly has now been confirmed [3]. It is estimated that This reply refers to the article available at
Neuroimaging patterns by means of transfontanellar ultrasound are accurate and diagnostic investigations of brain pathology in newborns affected by microcephaly and possible intrauterine ZIKV infection.
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