Chest X-ray and CT findings of early H7N9 avian influenza cases

Background: The H7N9 strain of bird flu is a new type of avian flu that was identified at the end of March 2013. The disease is concerning because most patients have become severely ill. Purpose: To study the X-ray and computed tomography (CT) findings of early H7N9 avian influenza cases. Material and Methods: Chest radiography and CT were performed in six patients with H7N9 avian influenza within 1-20 days after onset. The CT examinations included conventional spiral CT and high-resolution CT. The findings on the radiography and CT images were analyzed. Results: Abnormal X-ray and CT findings were present in all of the patients. All of the cases had acute onset. In the early stage, the right lung was more commonly affected (particularly in the right upper and middle lobes). The lesions rapidly expanded to the entire lungs and were characterized primarily by ground-glass opacities (GGOs) combined with consolidation. Diffuse GGO was observed in all six cases (1 was symmetric, and 5 were non-symmetric). Local consolidation was found in four cases, and lobar consolidation was found in two cases. Normal lung tissue was observed between the lesions. Pleural thickening was common and was combined with pleural/pericardial effusion or mediastinal lymph node enlargement. Reticular changes, centrilobular nodules, and the tree-in-bud sign were observed in some cases, but reticular changes, bronchial wall thickening, and hyperinflation were not found. Conclusion: Radiological changes associated with both acute pneumonia and acute interstitial inflammation were observed in early H7N9 avian influenza cases. Serial chest X-rays were useful for the diagnosis and severity assessment of the disease. CT may provide a more accurate assessment of the lung pathology.