Differential diagnoses of acute ground-glass opacity in chest computed tomography: pictorial essay / Diagnósticos diferenciais de opacidade em vidro fosco aguda na tomografia computadorizada de tórax: ensaio pictórico

ABSTRACT Ground-glass opacity is a very frequent and unspecified finding in chest computed tomography. Therefore, it admits a wide range of differential diagnoses in the acute context, from viral pneumonias such as influenza virus, coronavirus disease 2019 and cytomegalovirus and even non-infectious lesions, such as vaping, pulmonary infarction, alveolar hemorrhage and pulmonary edema. For this diagnostic differentiation, ground glass must be correlated with other findings in imaging tests, with laboratory tests and with the patients' clinical condition. In the context of a pandemic, it is extremely important to remember the other pathologies with similar findings to coronavirus disease 2019 in the imaging exams.

RESUMO A opacidade em vidro fosco é uma alteração muito frequente e pouco específica na tomografia computadorizada de tórax. Ela admite grande leque de diagnósticos diferenciais no contexto agudo, desde pneumonias virais, como as causadas pelo vírus influenza, pela doença do coronavírus 2019 e pelo citomegalovírus, até mesmo lesões de origem não infecciosa, como vaping , infarto pulmonar, hemorragia alveolar e edema pulmonar. Para essa diferenciação diagnóstica, deve-se correlacionar o vidro fosco com os demais achados nos exames de imagem, exames laboratoriais e quadro clínico do paciente. É de suma importância, no contexto de pandemia, recordar as demais patologias com os achados semelhantes aos da doença do coronavírus 2019 nos exames de imagem.

Clinical Profile of the H1N1 Influenza.

The H1N1 influenza A infection initially pandemic started in Mexico in March 2009 and spread as per WHO phases of pandemic alert all over the world. It was in late march 2009 an outbreak of a respiratory illness and later to proved to be caused by novel swine origin influenza A (S-OIV) identified in Mexico. Aims & Objectives : The aim of the present study was to describe first clinical presentation, various organ damage, treatment outcome duration of hospital stay and mortality and impact on high risk group patients. This is retrospective study hospital based Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli. Material and Methods: During post-pandemic period in 2010 the patients were admitted in hospitals which were suspected cases of H1N1 influenza “A” infection. 118 cases were studied August 2010 to 31st January 2011. Results : One hundred eighteen (118) patients were admitted in hospital. Of the 118 patients 32 patients were H1N1 positive and 86 patients H1N1 negative. RT- PCR test was done for confirmation of infection. X- Ray chest in positive cases of H1N1 influenza “A” infection bilateral extensive Pneumonititis other organ damage suggestive ECG, STT were changes renal failure common symptoms cough, fever, breathlessness in 28 cases sex-wise and age-wise distribution is not significant. Hospital stay all admitted patients and hospital stay in expired patients p value < 0.00 and < 0.005 highly significant. Statistics – percentage, ratio Chi- square tests used. Conclusion : Mortality in risk (Comorbid condition) with and without risk (ventilator required) The Mortality was 18.50 % more during the winter season (Chilly and cold atmosphere August to October during this season feverable for viability of the virus) significantly mortality is seen in young age group. This infection can be prevented by vaccination. The tablet tamiflu 75 mg 1 BD for 10 days no other adverse effects observed in our study the drug is safe and no resistance was observed.

comparison between the presentation of confirmed influenza A/H1N1/2009 virus infection and influenza-like illness among children admitted at Queen Alia military hospital

To describe the clinical characteristics of children who were hospitalized with respiratory infections during the year 2009 at Queen Alia Military Hospital in Amman and to compare features of confirmed influenza A/H1N1/ 2009 virus infections with features of Influenza-like illness. Hospitalized children under the age of 14 years with respiratory infections during the year 2009, with influenza A/H1N1/ virus infection were studied. All were tested with Real Time - Polymerase-Chain-Reaction [RT-PCR] assay for Influenza A/H1N1/ 2009 virus and chest radiography was done on admission. All were treated with Oseltamivir on admission till the laboratory results were available. During the study period, there were 77 admissions with respiratory infection. Only one death occurred. Forty-four [57%] were males, 44 had positive RT-PCR for influenza A/H1N1/2009 virus and 33[43%] tested negative and were considered, to have influenza-like illness. Comparing patients who had confirmed influenza A/H1N1/2009, to those with influenza-like illness, revealed that the mean age was 51 months versus 42 months. Underlying medical conditions were present in 70% versus 48% [p<0.001]. Chest radiographic findings were consistent with pneumonia in 100% versus 27% [p<0.001]. All patients had fever on admission. Dyspnoea was observed in 57% versus 33% [p<0.005]. Cough was seen in 91% versus 89% [p>0.05]. Vomiting affected 25% versus 18% [p>0.05]. Diarrhea occurred in 34% versus 21% [p>0.05]. Three patients had hematuria and one had croup, all were in the positively tested group. The patient that died had neurological disability and was tested positive for the infection. Influenza A/H1N1/ 2009 caused significant illness requiring hospitalization. When compared to patients with influenza-like illness, patients with influenza A/H1N1/2009 infections, were older, significantly more patients had dyspnoea, radiologically confirmed pneumonia and an underlying medical condition. Gastrointestinal symptoms were more common in patients with confirmed influenza A/H1N1/ 2009 infection, but the difference was not statistically significant

Chest imaging findings in children with influenza A [H1N1]

To assess imaging findings at presentation in children diagnosed with influenza A [H1N1] infection. This is a retrospective observational cohort study conducted at The Children's Hospital affiliated to Soochow University, Suzhou, China between September 2009 and March 2010. Nasopharyngeal swabs and bronchial aspirate samples from 81 children with acute respiratory infections were tested positive for influenza A [H1N1] using quantitative real-time polymerase chain reaction. Chest imaging for these patients was analyzed retrospectively by 2 independent radiologists for the presence and distribution of abnormalities. Chest radiograph findings consisted of bilateral patchy areas of consolidation [n=48], diffuse areas of air-space consolidation [n=18], and lobar consolidation [n=7]. Eight chest x-rays were normal. Abnormalities were observed more frequently in the lower lobes [bilateral [n=66], unilateral [n=7]]. Computed tomography [CT] scans were performed in 18 cases with air-space consolidation and interstitial opacities. Cases with diffuse areas of airspace consolidation were followed-up after 3 months by high resolution CT imaging, which showed interstitial thickening. The predominant imaging findings in childhood influenza A [H1N1] were bilateral patchy areas of consolidation, followed by diffuse areas of airspace consolidation, normal radiographs, and lobar consolidation