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Imaging Findings in a Fatal Case of Pandemic Swine-Origin Influenza A (H1N1)

¹ Department of Radiology and Imaging Sciences, National Institutes of Health, Clinical Center, Bethesda, MD.
² Department of Infectious Diseases, Flushing Hospital Medical Center, Flushing, NY.
³ Department of Medicine, Weill Cornell Medical College, New York, NY.
⁴ Department of Emergency Medicine, Flushing Hospital Medical Center, Flushing, NY.
⁵ Department of Critical Care Medicine, Flushing Hospital Medical Center, Flushing, NY.
⁶ Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University, 600 N Wolfe St., Baltimore, MD 21287.
⁷ Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
⁸ Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.

Abstract

OBJECTIVE. Although most cases of swine-origin influenza A (H1N1) virus (S-OIV) have been self-limited, fatal cases raise questions about virulence and radiology's role in early detection. We describe the radiographic and CT findings in a fatal S-OIV infection.

CONCLUSION. Radiography showed peripheral lung opacities. CT revealed peripheral ground-glass opacities suggesting peribronchial injury. These imaging findings raised suspicion of S-OIV despite negative H1N1 influenza rapid antigen test results from two nasopharyngeal swabs; subsequently, those results were proven to be false-negatives by reverse transcriptase polymerase chain reaction. This case suggests a role for CT in the early recognition of severe S-OIV.

Keywords: chest CT • emergency medicine • H1N1 • infectious diseases • multifocal ground-glass opacities • swine-origin influenza A

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