Severe Acute Respiratory Syndrome: Quantitative Assessment from Chest Radiographs with Clinical and Prognostic Correlation
Enoch K. Y. Lai1,
Hassan Deif1,
Elizabeth A. LaMere1,
Dieu H. Pham1,
Bryan Wolff2,
Sarah Ward3,
Barbara Mederski2 and
Mona R. Loutfy2
1 Department of Medical Imaging, North York General Hospital, 4001 Leslie St.,
Toronto, ON M2K 1E1, Canada.
2 Department of Medicine, North York General Hospital, Toronto, ON M2K 1E1,
Canada.
3 Toronto General Research Institute, University Health Network, 200 Elizabeth
St., Toronto, ON M5G 2C4, Canada.
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Fig. 1A. —67-year-old man with severe presentation of severe acute
respiratory syndrome (pattern A). Radiograph obtained on day 1 (first day of
symptoms onset) shows small unifocal opacity in right perihilar region.
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Fig. 1B. —67-year-old man with severe presentation of severe acute
respiratory syndrome (pattern A). Radiograph obtained on day 16 reveals
extensive bilateral air-space disease. Note that patient was intubated and had
small right pleural effusion (arrowheads).
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Fig. 1C. —67-year-old man with severe presentation of severe acute
respiratory syndrome (pattern A). Radiograph obtained on day 51 shows
significant but persistent opacities bilaterally. Patient was still
intubated.
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Fig. 2A. —30-year-old female nurse with typical presentation of severe
acute respiratory syndrome (pattern B). Radiograph obtained on day 6 from
symptoms onset reveals moderate unifocal air-space opacity in right lower lung
(arrows).
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Fig. 2B. —30-year-old female nurse with typical presentation of severe
acute respiratory syndrome (pattern B). Radiograph obtained on day 11 shows
typical progression of disease to bilateral patchy air-space opacities
(solid and broken arrows).
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Fig. 2C. —30-year-old female nurse with typical presentation of severe
acute respiratory syndrome (pattern B). Radiograph obtained at discharge on
day 22 shows gradual improvement, but findings shown in B
(arrows) have not resolved completely.
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Fig. 3A. —63-year-old woman with minimal radiographic findings of
severe acute respiratory syndrome (pattern C). Radiograph obtained on day 4
from symptoms onset shows subtle opacity in left upper lung
(arrow).
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Fig. 3B. —63-year-old woman with minimal radiographic findings of
severe acute respiratory syndrome (pattern C). Radiograph obtained on day 8
reveals slight increase in size of opacity. No new lesion was seen.
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Fig. 3C. —63-year-old woman with minimal radiographic findings of
severe acute respiratory syndrome (pattern C). Radiograph obtained on day 23
shows minimal residual disease in left upper lung.
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Fig. 4A. —Less common radiographic findings in patients with confirmed
severe acute respiratory syndrome (SARS). Radiograph obtained on day 6 of
25-year-old female nurse with pattern B of SARS shows multifocal masslike
opacities bilaterally (arrow and arrowheads).
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Fig. 4B. —Less common radiographic findings in patients with confirmed
severe acute respiratory syndrome (SARS). Radiograph obtained on day 11 of
53-year-old woman with pattern C0 of SARS reveals equivocal, subtle
findings in left lung base (arrows). Appearance did not change
significantly throughout course of disease.
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Fig. 5. —Scatterplot illustrates relationship between radiographic
(peak to 50% improvement time [PIT50]) and clinical disease
parameter (duration of oxygen supplementation) (r = 0.44).
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Fig. 6. —Graph illustrates three proposed disease patterns based on
chest radiographic findings: pattern A, peak to 50% improvement time
(PIT50) of more than 10 days; pattern B, PIT50 of 10 or
fewer days; and pattern C, minimal findings on chest radiographs during course
of entire disease. Three patients with pattern A had progressive deterioration
and died before onset of resolution (dotted curve).
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Fig. 7. —Diagram depicts proposed radiographic progression of severe
acute respiratory syndrome.
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Copyright © 2005 by the American Roentgen Ray Society.
