Type:
Educational Exhibit
Keywords:
Infection, Acute, Complications, Digital radiography, CT, Thorax
Authors:
G. Scavone1, M. C. Calcagno1, M. V. Raciti2, D. C. Caltabiano1, A. Scavone1; 1Catania/IT, 2Pavia, IT/IT
DOI:
10.26044/ecr2019/C-1855
Findings and procedure details
We evaluated imaging of pulmonary complications and laboratory data of patients with measles presented to our emergency department from January 2017 to February 2018 with respiratory symptoms (cough,
dyspnea,
hypoxiemia) associated with previous or concomitant onset of cranio-caudal maculopapular rash.
All these patients showed an immunocompromised status (anorexia,
drug addiction,
alcoholism).
The methods of imaging used were XR and TC.
In particular, CT scan was performed in doubtful cases of the radiograph examination and in cases of negative XR but with a strong clinical suspicion of lung involvement.
XR and CT prevalent findings observed were: interstitial pneumonia,
lobar pneumonia caused by bacterial sovrainfections,
and Acute Respiratory Distress Syndrome (ARDS).
CT showed a greater sensitivity and specificity in the detection of fine abnormalities of the lung parenchyma,
especially in case of changes in the attenuation of the pulmonary parenchyma.
The interstitial pneumonia manifested with thickening of the bronchial walls,
"ground-glass" (increase of attenuation of pulmonary parenchyma with visibility of the vessels),
centrilobular nodules,
interlobular and scissural thickening.
Lobar pneumonia presented with almost total involvement of a pulmonary lobe.
The XR showed a homogeneous opacification in a lobar pattern with a non-opacified bronchus within the consolidated lobe (air bronchograms).
The lobar distribution of consolidation is due to the spread of infection across segmental boundaries. Other common causes of lobar pneumonia includes: Streptococcus pneumoniae,
Klebsiella pneumoni,
Legionella pneumophila,
Haemophilus influenza and Mycobacterium tuberculosis.
ARDS was found in a single case complicated by pneumomediastinum,
pneumothorax,
pnemumomediastinum and subcutaneous emphysema.
The differential diagnosis varies according to the prevalent radiological pattern and includes infectious and non-infectious diseases.
It is very important to correlate imaging with clinical aspects in order to improve the accuracy of diagnosis.
The "ground glass" and lung consolidation can present in a wide spectrum of other diseases including fungal and bacterial infections,
bronchiolitis,
hypersensitivity pneumonitis,
alveolar proteinosis,
edema and pulmonary haemorrhage.
Pulmonary nodules are also common to many other diseases,
in particular the appearance of "tree in bud" is found in tuberculosis,
bronchopneumonia from non-tuberculous mycobacteria,
bronchiolitis.
Lobar pneumonia can be caused by many different kind of bacteria.
ARDS is the common epilog of very large spectrum of diseases.