Radiologic Manifestations of Potential Bioterrorist Agents of Infection
Loren Ketai1,
Abdulrahman A. Alrahji2,
Blaine Hart1,
Delia Enria3 and
Fred Mettler, Jr.1
1 Department of Radiology, University of New Mexico Health Science Center, 915
Camino de Salud N.E., Albuquerque, NM 87131-5336.
2 Department of Internal Medicine, Section of Infectious Diseases, King Faisal
Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
3 Instituto Nacional de Enfermedades Virales, Humana (INEVH) "J.
Maiztegui," Pergamino, Argentina.
View larger version (122K):
[in a new window]
|
Fig. 1A. —Middle-aged man with inhalational anthrax. Chest radiograph
at admission shows modest widening of right mediastinal contour at level of
carina. Note also subtle increase in bronchovascular opacities.
|
|
View larger version (132K):
[in a new window]
|
Fig. 1B. —Middle-aged man with inhalational anthrax. Chest radiograph
obtained next day shows marked mediastinal widening (accentuated by rightward
rotation), particularly in right paratracheal area. Markedly increased
bronchovascular opacities are seen radiating from hila.
|
|
View larger version (123K):
[in a new window]
|
Fig. 1C. —Middle-aged man with inhalational anthrax. CT scan of chest
obtained with IV contrast material on same day as radiograph B reveals
marked edema of mediastinal fat that obscures margins of lymph nodes in
paratracheal area. High-attenuation foci seen in right paratracheal soft
tissue (arrowheads) most likely represent hemorrhagic foci in lymph
nodes. Superior vena cava is compressed.
|
|
View larger version (130K):
[in a new window]
|
Fig. 2A. —Previously vaccinated middle-aged female health care worker
exposed to smallpox during epidemic. (Reprinted with permission from
[25]) Frontal chest radiograph
taken during acute illness shows multiple ill-defined patchy opacities in lung
parenchyma.
|
|
View larger version (82K):
[in a new window]
|
Fig. 2B. —Previously vaccinated middle-aged female health care worker
exposed to smallpox during epidemic. (Reprinted with permission from
[25]) Detail of right upper
lobe shows these findings more clearly.
|
|
View larger version (119K):
[in a new window]
|
Fig. 3A. —Middle-aged woman with "smallpox handler's lung."
(Reprinted with permission from
[25]) Frontal chest radiograph
during acute illness shows multiple small, ill-defined bilateral nodules.
|
|
View larger version (119K):
[in a new window]
|
Fig. 3B. —Middle-aged woman with "smallpox handler's lung."
(Reprinted with permission from
[25]) Frontal chest radiograph
taken several years after A shows interval calcification of numerous
nodules. Large calcification in right upper lobe was tuberculous in
origin.
|
|
View larger version (183K):
[in a new window]
|
Fig. 4. —2-year-old girl with smallpox. Bilateral radiograph of
forearms shows extensive periosteal reaction caused by smallpox. Arrow
indicates small area of radiolucency in distal ulnar metaphysis. (Reprinted
with permission from [27])
|
|
View larger version (155K):
[in a new window]
|
Fig. 5A. —14-year-old boy with secondary pneumonic plague. (Reprinted
with permission from [33])
Frontal chest radiograph shows bilateral nodular opacities.
|
|
View larger version (145K):
[in a new window]
|
Fig. 5B. —14-year-old boy with secondary pneumonic plague. (Reprinted
with permission from [33])
Within 24 hr, these nodular opacities progressed to diffuse air-space disease.
Plague pneumonia was confirmed at autopsy.
|
|
View larger version (124K):
[in a new window]
|
Fig. 6. —30-year-old woman with secondary plague pneumonia. Frontal
chest radiograph shows left lower lobe air-space disease with formation of
large cavity. Cavitation occurred after 2 weeks of illness and is an uncommon
manifestation of plague.
|
|
View larger version (141K):
[in a new window]
|
Fig. 7. —3-year-old boy with bubonic plague. Chest radiograph shows
extensive mediastinal adenopathy. Bubo can also been seen in left axilla
(arrow).
|
|
View larger version (137K):
[in a new window]
|
Fig. 8A. —51-year-old woman with tularemia. (Courtesy of Rubin S,
Galveston, TX) Chest radiograph shows patchy segmental opacities and right
hilar adenopathy.
|
|
View larger version (136K):
[in a new window]
|
Fig. 8B. —51-year-old woman with tularemia. (Courtesy of Rubin S,
Galveston, TX) Follow-up radiograph several days later shows some areas have
cavitated and right pleural effusion has developed.
|
|
View larger version (141K):
[in a new window]
|
Fig. 9. —40-year-old man with tularemia acquired from aerosol
exposure. Chest radiograph taken 2 weeks after initial appearance of left lung
infiltrate shows cavitary air-space disease in mid and upper left lung. Note
moderate left hilar adenopathy (arrow). (Courtesy of Miller SW,
Boston, MA)
|
|
View larger version (146K):
[in a new window]
|
Fig. 10. —37-year-old man with Q fever pneumonia. Posteroanterior chest
radiograph shows consolidation of medial segment of right middle lobe.
(Courtesy of Gikas A and Tritou I, Heraklion, Crete, Greece)
|
|
View larger version (73K):
[in a new window]
|
Fig. 11. —46-year-old man with Q fever pneumonia. CT scan shows
multiple patchy, nodular areas of consolidation located peripherally in both
right and left lungs. Some of these opacities appear to have feeding vessel
and halo of ground-glass opacification, appearance similar to CT images of
septic emboli. (Courtesy of Gikas A and Tritou I, Heraklion, Crete,
Greece)
|
|
View larger version (116K):
[in a new window]
|
Fig. 12A. —14-year-old boy with eastern equine encephalitis that
occurred as a sporadic case in 2001. (Courtesy of Quint D, Ann Arbor, MI) CT
scans show low-attenuation in area of left basal ganglia and internal capsule
(arrowheads, A) with obliteration of left anterior temporal
horn of lateral ventricle.
|
|
View larger version (121K):
[in a new window]
|
Fig. 12B. —14-year-old boy with eastern equine encephalitis that
occurred as a sporadic case in 2001. (Courtesy of Quint D, Ann Arbor, MI) CT
scans show low-attenuation in area of left basal ganglia and internal capsule
(arrowheads, A) with obliteration of left anterior temporal
horn of lateral ventricle.
|
|
View larger version (121K):
[in a new window]
|
Fig. 13. —Another 14-year-old boy with eastern equine encephalitis. CT
scan shows low attenuation (arrowheads) in area of basal ganglia and
thalamus that appears similar to that in Figure
12A,12B.
(Reprinted with permission from
[43])
|
|
View larger version (141K):
[in a new window]
|
Fig. 14. —Yet another 14-year-old boy with eastern equine encephalitis.
T2-weighted MR image shows high signal intensity (arrowheads) in area
of left basal ganglia. (Reprinted with permission from
[43])
|
|
View larger version (140K):
[in a new window]
|
Fig. 15. —65-year-old man with herpes encephalitis. T2-weighted MR
image shows diffuse high signal intensity in left temporal lobe
(arrow). Focal area of low signal intensity in medial aspect of lobe
is consistent with hemorrhage (arrowhead). Although herpes simplex
may also cause fulminant encephalitis, predilection for involvement of
temporal lobes is markedly different from distribution of eastern equine
encephalitis seen in Figure
14.
|
|
View larger version (124K):
[in a new window]
|
Fig. 16A. —50-year-old man with hantavirus pulmonary syndrome. Chest
radiograph early in course of disease shows marked interstitial edema.
|
|
View larger version (118K):
[in a new window]
|
Fig. 16B. —50-year-old man with hantavirus pulmonary syndrome. Chest
radiograph taken 48 hr later shows interval development of extensive air-space
disease.
|
|
View larger version (122K):
[in a new window]
|
Fig. 17. —Middle-aged man with Lassa fever. Chest radiograph shows mild
interstitial edema, which later worsened (not shown) after aggressive fluid
volume resuscitation. (Courtesy of Bausch D, Atlanta, GA)
|
|
View larger version (130K):
[in a new window]
|
Fig. 18A. —18-year-old woman with Rift Valley fever. Patient with visual
symptoms and encephalitis was confirmed to have positive serology findings for
acute Rift Valley fever infection during recent outbreak in Saudi Arabia.
Initial CT of brain had normal findings (not shown). Neurologic symptoms of
lethargy, confusion, and paralysis persisted. Repeated CT scans without
(A) and with (B) IV contrast material. Both images show multiple
areas of low attenuation in cerebral cortex, most prominently in occipital
lobes (arrows). Although similar appearance can be caused by
microvascular damage to occipital white matter as a result of hypertensive
encephalopathy, patient had no history of hypertension.
|
|
View larger version (128K):
[in a new window]
|
Fig. 18B. —18-year-old woman with Rift Valley fever. Patient with visual
symptoms and encephalitis was confirmed to have positive serology findings for
acute Rift Valley fever infection during recent outbreak in Saudi Arabia.
Initial CT of brain had normal findings (not shown). Neurologic symptoms of
lethargy, confusion, and paralysis persisted. Repeated CT scans without
(A) and with (B) IV contrast material. Both images show multiple
areas of low attenuation in cerebral cortex, most prominently in occipital
lobes (arrows). Although similar appearance can be caused by
microvascular damage to occipital white matter as a result of hypertensive
encephalopathy, patient had no history of hypertension.
|
|
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
Copyright © 2003 by the American Roentgen Ray Society.
