Dynamic CT Features of Inhalational Anthrax Infection

Dynamic CT Features of Inhalational Anthrax Infection

Christopher M. Krol¹, Martin Uszynski¹, Evan H. Dillon¹, Mina Farhad¹, Stephen C. Machnicki¹, Bushra Mina² and Lewis M. Rothman¹

^¹ Department of Diagnostic Radiology, Lenox Hill Hospital, 100 E. 77th St., New York, NY 10021.
^² Department of Internal Medicine, Division of Critical Care Medicine, Lenox Hill Hospital, New York, NY 10021.

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Fig. 1A. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. Initial anteroposterior upright chest radiograph shows widened superior mediastinum, bilateral perihilar infiltrates, and pleural effusions.

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Fig. 1B. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. Supine chest radiograph obtained 12 hr after A shows further widening of mediastinum, marked hilar enlargement, and apparent increase in pleural effusions.

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Fig. 1C. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. Dynamic CT scan obtained 16 hr after A at level of left atrium shows large bilateral pleural effusions with high-density material (white arrows) on dependent right pleural surface. Note amount of heterogeneous material in mediastinum, compressing the hilar vessels and left atrium (black arrows).

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Fig. 1D. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. Initial axial CT scan obtained at level of aortic arch shows extensive paratracheal tissue and edema (arrows) infiltrating mediastinal fat.

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Fig. 1E. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. Magnified CT scan obtained at subcarinal level shows bronchial mucosal thickening (arrows).

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Fig. 1F. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. CT scan obtained using lung window settings on exhalation shows perihilar opacities with sparing of peripheral lung segments.

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Fig. 1G. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. CT scan obtained 20 min after initial contrast bolus through subcarinal region shows confluent, ill-defined ringlike areas of enhancement (arrows). Note central hypodensity associated with hemorrhagic lymphadenopathy.

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Fig. 1H. —61-year-old woman with history of hypertension who presented to emergency department with worsening shortness of breath, dyspnea at rest, and substernal pain that had begun 3 days earlier. Delayed CT scan shows pericardial effusion (open arrows) and paraesophageal hemorrhagic adenopathy (solid arrows).

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