Radiologic Pattern of Disease in Patients with Severe Acute Respiratory Syndrome: The Toronto Experience

Paul, Narinder; Roberts, Heidi C.; Butany, Jagdish; Chung, Taebong; Gold, Wayne L.; Mehta, Sangeeta; Konen, Eli; Rao, Anuradha; Provost, Yves; Hong, Harry H.; Zelovitsky, Leon; Weisbrod, Gordon L.

doi:10.1148/rg.242035193

Cited by 89 publications

(79 citation statements)

References 13 publications

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“…High-resolution chest CT findings of SARS have been described by Wong et al, 17 Chan et al, 18 and Paul et al 14 The most common findings are ground-glass opacities and crazy paving. Hui et al 19 suggest that high-resolution chest CT is useful for early diagnosis of SARS in patients with negative radiographs.…”

Section: Severe Acute Respiratory Syndromementioning

confidence: 90%

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients

Kirsch

Ramírez²,

Mohammed³

et al. 2011

Journal of Thoracic Imaging

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Acute respiratory illness is defined as one or more of the following: cough, sputum production, chest pain, or dyspnea (with or without fever). The workup of these patients depends on many factors, including clinical presentation and the suspected etiology. This study reviews the literature on the indications and usefulness of radiologic studies for the evaluation of acute respiratory illness in the immunocompetent patient. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology. Chest radiographs are usually appropriate in (1) patients with positive physical examination or risk factors for pneumonia, (2) for the assessment of complicated pneumonia, or (3) in cases of emerging infections and biological warfare agents such as severe acute respiratory syndrome, H1N1, and anthrax. Computed tomography, although having a more limited role, is usually appropriate (1) in the assessment of complicated pneumonia and (2) in patients with suspected severe acute respiratory syndrome, H1N1, or anthrax and a normal radiograph.

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Section: Severe Acute Respiratory Syndromementioning

confidence: 90%

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients

Kirsch

Ramírez²,

Mohammed³

et al. 2011

Journal of Thoracic Imaging

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“…The abnormalities on initial chest radiographs were assessed as focal opacity or multifocal or diffuse opacity (15). Parenchymal opacity was defined as an area that appears denser than the surrounding lung tissue without a discrete border.…”

Section: Methodsmentioning

confidence: 99%

Clinical Features and Radiological Findings of Adenovirus Pneumonia Associated with Progression to Acute Respiratory Distress Syndrome: A Single Center Study in 19 Adult Patients

et al. 2016

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ObjectiveTo describe radiologic findings of adenovirus pneumonia and to understand clinico-radiological features associated with progression to acute respiratory distress syndrome (ARDS) in patients with adenovirus pneumonia.Materials and MethodsThis study included 19 patients diagnosed with adenovirus pneumonia at a tertiary referral center, in the period between March 2003 and April 2015. Clinical findings were reviewed, and two radiologists assessed imaging findings by consensus. Chi-square, Fisher's exact, and Student's t tests were used for comparing patients with and without subsequent development of ARDS.ResultsOf 19 patients, nine were immunocompromised, and 10 were immunocompetent. Twelve patients (63%) progressed to ARDS, six of whom (32%) eventually died from the disease. The average time for progression to ARDS from symptom onset was 9.6 days. Initial chest radiographic findings were normal (n = 2), focal opacity (n = 9), or multifocal or diffuse opacity (n = 8). Computed tomography (CT) findings included bilateral (n = 17) or unilateral (n = 2) ground-glass opacity with consolidation (n = 14) or pleural effusion (n = 11). Patients having subsequent ARDS had a higher probability of pleural effusion and a higher total CT extent compared with the non-ARDS group (p = 0.010 and 0.007, respectively). However, there were no significant differences in clinical variables such as patient age and premorbid condition.ConclusionAdenovirus pneumonia demonstrates high rates of ARDS and mortality, regardless of patient age and premorbid conditions, in the tertiary care setting. Large disease extent and presence of pleural effusion on CT are factors suggestive of progression to ARDS.

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“…2,3 Various treatment regimens have been used as therapy for SARS. In the spring of 2003 SARS was carried to Hong Kong by an ill physician, and from there spread to other nations including Canada, Singapore, and Viet Nam 1 Before rigorous public health measures could contain the disease, 8098 patients were infected and 774 died.…”

mentioning

confidence: 99%

“…In the spring of 2003 SARS was carried to Hong Kong by an ill physician, and from there spread to other nations including Canada, Singapore, and Viet Nam 1 Before rigorous public health measures could contain the disease, 8098 patients were infected and 774 died. 3 Systemic corticosteroid treatment was also commonly administered during the SARS epidemic, including high dose ''pulse'' corticosteroids used to treat patients showing continued clinical deterioration. Although no human infections have occurred since 2003 the infection possibly remains in mammalian reservoirs in China and Southeast Asia.…”

mentioning

confidence: 99%

Radiology of Severe Acute Respiratory Syndrome (SARS)

Ketai

Paul

Wong

2006

Journal of Thoracic Imaging

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Severe acute respiratory distress syndrome (SARS) caused by SARS-associated coronavirus (SARS-CoV) is a systemic infection that clinically manifests as progressive pneumonia. During the initial phases of infection the virus causes pauci-inflammatory alveolar and interstitial edema that result in imaging abnormalities dominated by ground glass opacities (GGO). Severe SARS cases can develop radiologic and pathologic findings of diffuse alveolar damage. Although radiologic evidence of acute bronchiolitis is absent, SARS-CoV also infects ciliated airway epithelium, probably accounting for respiratory transmissibility of the virus. Radiologic recovery from SARS can be complete, but computed tomography images often show persistent GGO and reticular opacities, some of which reflect pathologic findings of fibrosis. Long-term follow-up imaging of survivors shows gradual decrease of GGO and reticulation with persistent air trapping in some patients. The latter is evidence of small airway disease that is not radiologically evident at the onset of the disease.

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Radiologic Pattern of Disease in Patients with Severe Acute Respiratory Syndrome: The Toronto Experience

Cited by 89 publications

References 13 publications

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients

ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients

Clinical Features and Radiological Findings of Adenovirus Pneumonia Associated with Progression to Acute Respiratory Distress Syndrome: A Single Center Study in 19 Adult Patients

Radiology of Severe Acute Respiratory Syndrome (SARS)

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