title: Bedside chest radiography of novel influenza A (H7N9) virus infections and follow-up findings after short-time treatment.
abstract: BACKGROUND
  Influenza A (H7N9) virus infections were first observed in China in March 2013. This type virus can cause severe illness and deaths, the situation raises many urgent questions and global public health concerns. Our purpose was to investigate bedside chest radiography findings for patients with novel influenza A (H7N9) virus infections and the followup appearances after short-time treatment.
  
  
  METHODS
  Eight hospitalized patients infected with the novel influenza A (H7N9) virus were included in our study. All of the patients underwent bedside chest radiography after admission, and all had follow-up bedside chest radiography during their first ten days, using AXIOM Aristos MX and/or AMX-IV portable X-ray units. The exposure dose was generally 90 kV and 5 mAs, and was slightly adjusted according to the weight of the patients. The initial radiography data were evaluated for radiological patterns (ground glass opacity, consolidation, and reticulation), distribution type (focal, multifocal, and diffuse), lung zones involved, and appearance at follow-up while the patients underwent therapy.
  
  
  RESULTS
  All patients presented with bilateral multiple lung involvement. Two patients had bilateral diffuse lesions, three patients had unilateral diffuse lesions of the right lobe with multifocal lesions of the left lobe, and the remaining three had bilateral multifocal lung lesions. The lesions were present throughout bilateral lung zones in three patients, the whole right lung zone in three patients with additional involvement in the left middle and/or lower lung zone(s), both lower and middle lung zones in one patient, and the right middle and lower in combination with the left lower lung zones in one patient. The most common abnormal radiographic patterns were ground glass opacity (8/8), and consolidation (8/8). In three cases examined by CT we also found the pattern of reticulation in combination with CT images. Four patients had bilateral and four had unilateral pleural effusion. After a short period of treatment the pneumonia in one patient had significantly improved and three cases demonstrated disease progression. In four cases the severity of the pneumonia fluctuated.
  
  
  CONCLUSIONS
  In patients with influenza A (H7N9) virus infection, the distribution of the lung lesions are extensive, and the disease usually involves both lung zones. The most common imaging findings are a mixture of ground glass opacity and consolidation. Pleural effusion is common. Most cases have a poor short-time treatment response, and seem to have either rapid progressive radiographic deterioration or fluctuating radiographic changes. Chest radiography is helpful for evaluating patients with severe clinical symptoms and for follow-up evaluation.
authors.affiliation: Department of Radiology, Shanghai Public Health Clinical Center, Shanghai 201508, China.
authors.forename: Feng-xiang
authors.initials: FX
authors.lastname: Song
authors.forename: Jun
authors.initials: J
authors.lastname: Zhou
authors.forename: Yu-xin
authors.initials: YX
authors.lastname: Shi
authors.forename: Zhi-yong
authors.initials: ZY
authors.lastname: Zhang
authors.forename: Feng
authors.initials: F
authors.lastname: Feng
authors.forename: Jian-jun
authors.initials: JJ
authors.lastname: Zhou
authors.forename: Qing-le
authors.initials: QL
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D064766:Influenza A Virus, H7N9 Subtype / Q000502:physiology*; D007251:Influenza, Human / Q000000981:diagnostic imaging* / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D011859:Radiography