title: Severe influenza A (H1N1): the course of imaging findings.
abstract: BACKGROUND
  An outbreak of respiratory illness caused by a novel swine-origin influenza virus (influenza A/H1N1 2009) that began in Mexico was declared a global pandemic by the World Health Organization in June 2009. The pandemic affected many countries, including Israel.
  
  
  OBJECTIVE
  To compare the course of chest radiographic and computed tomography findings in patients who survived and those who died following admission to the intensive care unit (ICU) or intubation due to severe laboratory-confirmed swine-origin influenza A/H1N1 2009.
  
  
  METHODS
  We retrospectively reviewed the patient records (267 radiographs, 8 CTs) of 22 patients (10 males, 12 females) aged 3.5-66 years (median 34) with confirmed influenza A/ H1N1 2009, admitted to the ICU and/or intubated in five major Israeli medical centers during the period July-November 2009. We recorded demographic, clinical, and imaging findings--including pattern of opacification, extent, laterality, distribution, zone of findings, and presence/absence of nodular opacities--at initial radiography and during the course of disease, and compared the findings of survivors and non-survivors. Statistical significance was calculated using the Wilcoxon (continuous variables) and Fisher exact tests.
  
  
  RESULTS
  The most common findings on the initial chest radiography were airspace opacities, which were multifocal in 17 patients (77%) and bilateral in 16 (73%), and located in the lower or lower and middle lung zones in 19 patients (86%). Large airspace nodules with indistinct margins were seen in 8 patients (36%). Twelve patients survived, 10 died. Patients who died had multiple background illnesses and were significantly older than survivors (P = 0.006). Radiologic findings for the two groups were not significantly different.
  
  
  CONCLUSIONS
  Airspace opacities, often with nodular appearance, were the most common findings among patients with severe influenza A/H1N1 2009. The course of radiologic findings was similar in patients with severe influenza A/ H1N1 2009 who survived and those who died.
authors.affiliation: Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. dshaham@hadassah.org.il
authors.forename: Dorith
authors.initials: D
authors.lastname: Shaham
authors.forename: Naama R
authors.initials: NR
authors.lastname: Bogot
authors.forename: Galit
authors.initials: G
authors.lastname: Aviram
authors.forename: Ludmila
authors.initials: L
authors.lastname: Guralnik
authors.forename: Sivan
authors.initials: S
authors.lastname: Lieberman
authors.forename: Laurian
authors.initials: L
authors.lastname: Copel
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Itamar
authors.initials: I
authors.lastname: Grotto
authors.forename: Dan
authors.initials: D
authors.lastname: Engelhard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D005260:Female; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000000981:diagnostic imaging* / Q000401:mortality; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed