Radiology of Infectious Diseases最新文献

Objective

Melioidosis is a neglected tropical disease caused by the Burkholderia pseudomallei bacterium. Currently, serologically-proven cases are likely to represent only the ‘tip of the iceberg’ as culture facilities are not widely available within endemic areas. With globally increasing population and temperatures, it is hypothesised that areas which B. pseudomallei is endemic to will expand. Melioidosis confers significant mortality and morbidity and is associated with a diverse range of imaging findings. This pictorial essay aims to describe the common and life-threatening imaging features of melioidosis.

Methods

A retrospective review was undertaken on imaging performed in culture-confirmed cases of melioidosis at a single institution over a 5-year period.

Results

Typical and atypical imaging findings demonstrating involvement of multiple organs are presented.

Conclusion

Effective treatment for melioidosis requires early diagnosis and a multi-disciplinary approach with involvement of physicians, surgeons, and interventional radiologists. Where available, early CT imaging should be performed to investigate potential bacterial seeding. Radiologists working in endemic areas or examining returned overseas travellers should be familiar with the imaging findings to aid diagnosis and management in these patients.

The coronavirus disease 2019 (COVID-19) first emerged in Wuhan, China on December 2019 and has become a severe public health issue worldwide. A 36-year-old man was presented to the hospital staff with a fever that had already persisted for a three-day period, general weakness and diarrhea. He had no chronic diseases and was tested positive for COVID-19 with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. During his hospitalization, several abnormal indicators appeared in his laboratory tests, which implied systemic inflammation and multiple organ damage. A series of chest radiographs monitored the dynamic process of lung lesions, which could predict the clinical changes of the patient. His condition deteriorated rapidly, resulting in death due to acute respiratory distress syndrome (ARDS) on hospital day 13. The case indicates that inflammatory response may appear in people infected with SARS-CoV-2 and may lead to multiple organ damage (especially pancreatic damage). When a COVID-19 patient is entering into the critical stage, their condition could rapidly deteriorate.

Objective

To explore the initial CT features and dynamic evolution of early-stage patients with Coronavirus disease 2019 (COVID-19).

Methods

A total of 126 COVID-19 patients in the early stage were enrolled. The initial CT features and dynamic evolution characteristics of the progression and absorption process from the stage of admission to discharge were retrospectively analyzed in this study.

Results

The main initial CT features were as follows: bilateral distribution (112/126, 88.9%), diffuse distribution (106/126, 84.1%), multiple lesions (117/126, 92.9%), nodular shapes (84/126, 66.7%), patchy shapes (98/126, 77.8%), pure ground-glass opacities (GGO) (95/126, 75.4%), “vascular thickening sign” (98/126, 77.8%), “air bronchogram sign” (70/126, 55.6%), “crazy paving pattern” (93/126, 73.8%), and “pleura parallel sign” (72/126, 57.1%). The main dynamic evolution characteristics were as follows: ① Imaging findings of the progression process: the main CT changes were increased GGOs with consolidation (118/126, 93.7%), an increased “crazy paving pattern” (104/126, 82.5%), an increased “vascular thickening sign” (105/126, 83.3%), and an increased “air bronchogram sign” (95/126, 75.4%); ② Imaging findings of the absorption process: the main CT changes were the obvious absorption of consolidation displayed as inhomogeneous partial GGOs with fibrosis shadows, the occurrence of a “fishing net on trees sign” (45/126, 35.7%), an increased “fibrosis sign” (40/126, 31.7%), an increased “subpleural line sign” (35/126, 27.8%), a decreased “crazy paving pattern” (19.8%), and a decreased “vascular thickening sign” (23.8%); and ③ In the stage of discharge, the main CT manifestations were further absorption of GGOs, consolidation and fibrosis shadows in the lung, and no appearance of new lesions, with only a small amount of shadow with fibrotic streaks and reticulations remaining in some cases (16/126, 12.7%).

Conclusion

The initial CT features and dynamic evolution of early-stage patients with COVID-19 have certain characteristics and regularity; CT of the chest is critical for early detection, evaluation of disease severity and follow-up of patients.

Tuberculosis (TB) is a major public health issue in developing countries. Among all varieties of TB, central nervous system tuberculosis (CNS-TB) is the most life-threatening, and causes high mortality and morbidity even with appropriate anti-TB therapy. The key to avoid devastating outcomes is early and prompt diagnosis and treatment. Hence, insights into the characteristics and clinical presentations are desperately needed. Traditional diagnostic techniques, however, are time-consuming and insensitive. Newly-developing nanotechnology and nanomaterials have already been applied in the detection of causative agents and delivery of anti-TB drugs. In this review, we summarize the typical clinical presentations and signs of CNS-TB, analyze the pros and cons of routine laboratory diagnostic techniques, introduce the current treatment therapies and update on the progress on development and application of nano-scale biosensors and drug delivery systems for CNS-TB.

Hemoperitoneum secondary to splenic rupture is a rare complication which is associated with dengue fever. A high degree of suspicion and an early diagnosis can save lives. A 28-year old male patient was admitted with warning signs on day 5 of dengue fever to our intensive care unit (ICU). His condition deteriorated rapidly with worsening abdominal distension and pain. In view of a previously noted episode of hypotension, he underwent further fluid resuscitation and Rapid Ultrasound for Shock and Hypotension (RUSH) protocol on admission to ICU which noted free fluid in abdomen prompting diagnostic aspiration. Aspirate confirmed hemoperitoneum leading to contrast enhanced computed tomography (CECT) of the abdomen revealed splenic hematoma with venous extravasation. He underwent splenic artery embolization within the next few hours in view of continued bleeding despite correction of the thrombocytopenia and coagulation parameters. His period in ICU was complicated by recurrent bleeding after 48 h which warranted abdominal CT followed by embolization of the splenic artery. There is a low threshold to undertake imaging for disproportionate ascites in severe dengue. This case shows the successful management of a rare complication of dengue with timely endovascular intervention.

Schistosomiasis is a neglected disease caused by trematode worms, affecting multiple target organs (predominantly the liver and urinary system) and presenting in wide spectrum including both acute and chronic forms; potential risks include liver fibrosis, portal hypertension, urinary tract obstruction, hydronephrosis, bladder cancer and reproductive tract disease. Diagnosis is mainly based on the evidence of infestation by parasitological, serological and molecular methods in body fluids (urine, stools and blood) and/or tissue specimens. Diagnostic imaging modalities (Ultrasonography, US; Computed Tomography, CT; Magnetic Resonance Imaging, MRI) support clinical-laboratoristic diagnosis with added value in evaluation of severity of morbidity and effectiveness of treatments. In most cases, early repeated anthelmintic chemotherapy can prevent the onset of advanced disease manifestations. Interventional radiology may offer an effective treatment option in case of variceal bleeding in advanced liver disease with portal hypertension resistant to conventional therapies.

The high mortality of aquired immune deficiency syndrome (AIDS)-related cerebral toxoplasmosis is one of the serious complications affecting the survival and prognosis of AIDS patients. The most important reason is the difficulty to diagnose. The gold standard for diagnosis of the disease is biopsy of brain tissue. However, this method is not easy to carry out clinically. The diagnostic efficiency of serum and cerebrospinal fluid antibody titers, polymerase chain reaction (PCR) and other methods are low. Although the imaging manifestations of cerebral toxoplasmosis in AIDS are variable, there are some characteristic features. It is very important to correctly recognize its characteristic imaging features and use related imaging methods to help diagnose this disease. The purpose of this paper is to provide consensus for the imaging characteristics of AIDS-related cerebral toxoplasmosis.

Objective

To analyze the CT imaging results of patients with COVID-19 who previously received several follow-up visits and to explain the changes in pulmonary inflammation.

Methods

Cases of 15 patients with COVID-19 were retrospectively analyzed: their epidemiology, clinical history, laboratory tests, and multiple CT chest scans obtained during the disease period were studied.

Results

The CT scans of the 15 patients showed different results. Four patients had no abnormal findings in their chest CT scans. The first scan of 1 patient revealed right lower lobe inflammation, while the lesion had been completely absorbed in follow-up. Two patients showed bilateral pulmonary inflammation in the first scan which had been absorbed by follow-up but the last examination showed extensive fibrosis. Two patients had no abnormalities in their first CT scans, while pulmonary inflammation was found in the second scan and this had not been completely absorbed by the last follow-up. One patient had pulmonary interstitial lesions with no evidence of National Cochlear Implant Programme (NCIP) on the first and second CT scans. NCIP was found at the third scan, and pulmonary inflammation was not completely absorbed at the last follow-up. Three patients were in the early stage of inflammation at the first scan, and the lesions were absorbed and repaired at the last follow-up. However, the lesions were not completely absorbed. One patient was in the advanced stage at the first scan, and the last follow-up pulmonary lesions were not completely absorbed. The first CT scan of 1 patient revealed large ground-glass opacity in the lungs involving the inner and middle bands. After follow-up, the disease progressed, and this condition was consistent with severe manifestations.

Conclusion

The follow-up of chest CT can reflect the change process of NCIP and the treatment effect. The first CT scan of lung lesions has a certain predictive effect on the outcome and prognosis of patients.

On December 31, 2019, the Wuhan Health Commission reported the discovery of an “unexplained” pneumonia for the first time; the pathogen was confirmed as novel coronavirus pneumonia (2019-nCoV) on January 7, 2020. As one of the important examination methods for the coronavirus diseases 2019 (COVID-19), Computed Tomography (CT) examination plays an important role in the clinical discovery of suspected cases, diagnosis, and treatment review. This paper reviews the published papers in order to offer help in early clinical screening, disease diagnosis, disease severity determination and post-treatment review.

Objective

To investigate in the CT manifestations of severe and critical coronavirus disease 2019 (COVID-19) patients.

Methods

Medical data was collected for 2 severe patients and 4 critical COVID-19 patients from onset to their recovery. Three or four CT scans for each patient were taken. The semi-quantitative analysis method was introduced for lesion and its distribution area.

Results

The ground-glass opacities (GGO) and mixed GGO with consolidation were found as the most frequent features. Consolidation followed, and the appearance of stripes which showed an increasing trend before the patient was discharged. Consolidation was associated with clinical severity and disease progression, and the rapid change of the lesion in a short period of time was also a notable feature within 2–3 weeks. After being discharged, the efficacy of treatment could be demonstrated by a follow up CT scan. The distribution of lesion also showed dynamic progress in the follow up CT scan.

Conclusion

CT scans in the whole course provided the entire inflammation information to assess clinical severity, disease progression and the treatment efficacy for COVID-19.