Radiological findings of pneumonia in patients with swine-origin influenza A virus (H1N1).

PURPOSE: During spring 2009, a pandemic swine-origin influenza A (H1N1) virus (S-OIV) emerged and spread globally. We describe the chest X-ray and computed tomography (CT) findings of 40 patients with pneumonia due to S-OIV observed in our institution. MATERIAL AND METHODS: Among 534 patients with S-OIV, according to the US Centers for Disease Control and Prevention case definition, seen between June and November 2009, 121 underwent chest X-ray and 40 (median age 44 years, range 16-79) had pneumonia. The initial chest radiographs were evaluated for pattern, distribution and extent of lung abnormalities. Unenhanced chest CT scans were performed in two patients and were reviewed for the same findings. Underlying medical conditions were present in 42% of patients (17/40). RESULTS: Our patients had predominantly mild illness, and pneumonia was observed in 40 individuals (40/121 patients who had chest X-rays, 33%; and 40/534 patients with S-OIV, 7.5%). However, S-OIV can cause severe illness requiring admission to the intensive care unit for advanced mechanical ventilation and extracorporeal life support, including adult respiratory distress syndrome (ARDS) and death. The major radiological abnormalities observed were interstitial changes (60.0%), with (22.0%) or without patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones (7.5%). Extensive disease was seen in 37.5% (15/40), and ARDS was observed in three individuals (0.30%)with underlying medical conditions. Subtle pleural effusion was noted in four patients. CONCLUSIONS: In our series, the most frequent pneumonia patterns observed during S-OIV (H1N1) virus were interstitial changes and patchy ground-glass appearance, mostly bilateral, and located in the lower lung zones. CT, performed in severely ill patients, confirmed the ARDS identified with chest X-rays, better depicting the features and extent of lung abnormalities.

Infectious spondylodiscitis: magnetic resonance imaging in HIV-infected and HIV-uninfected patients.

OBJECTIVE: We retrospectively reviewed 21 infections of the spine to correlate magnetic resonance imaging (MRI) with etiology of spondylodiscitis according to HIV status. CONCLUSION: MRI allowed the differentiation between tuberculous and pyogenic spondylodiscitis in the chronic stage. Typical findings were not observed in HIV+ as compared with HIV- patients, either concerning etiology or characteristic features of the spondylodiscitis.

High contrast enhancement of the liver in CT by repeated doses of contrast medium.

A technique consisting of repeated injections of contrast medium has been used in 530 cases of upper abdominal CT studies for evaluation of hepatic and pancreatic disease. Out of 530 cases, 105 patients had hepatic lesions, 62 metastatic, 3 adenomas, 4 haemangiomas and 6 hepatomas. The remaining 30 patients had cystic lesions involving the liver. Using a repeat dose technique and rapid scanning, the accuracy rate ranged about 90%. Th authors feel that this technique should be employed routinely for evaluation of hepatic problems and that other techniques should be abandoned.

Characteristic CT pattern of giant superior mesenteric artery aneurysms.

The presence of superior mesenteric artery aneurysms may be suspected on the basis of clinical and ultrasound findings. These lesions have a suggestive appearance on computed tomography, but for a preoperative assessment angiography is always indicated. Two cases are presented.

Emergency transhepatic obliteration of bleeding varices.

Transhepatic obliteration of gastroesophageal varices was performed in 18 actively bleeding patients. The success of the procedure was related to the complete obliteration of the varices, as demonstrated by their disappearance at angiography. In 13 of the 14 patients in whom obliteration was complete, bleeding did not recur. Three of the 13 died of hepatic insufficiency within 18 days of embolization, and three refused surgery and were lost to follow-up. The remaining seven patients had portacaval or mesocaval shunts, and are doing well at a follow-up of 12 months. Transhepatic obliteration has, therefore, proved to be an effective emergency procedure in patients who will be acceptable surgical candidates at a later date.