title: Scrub typhus: radiological and clinical findings in abdominopelvic involvement.
abstract: OBJECTIVE
  To describe the clinical and radiological findings of abdominopelvic involvement in scrub typhus.
  
  
  METHODS
  Abdominopelvic computed tomography (CT) of 78 patients with scrub typhus were evaluated by two readers. The presence of gallbladder wall thickening, arterial inhomogeneous enhancement of the liver, periportal edema, splenic infarction, hepatomegaly, splenomegaly, ascites, pleural effusion, and sites of lymphadenopathy were evaluated. Patients were divided into four clinical subgroups according to laboratory findings. Association between imaging findings and subgroups was analyzed by Chi squared test or Fisher's exact test.
  
  
  RESULTS
  The most common CT finding was hepatomegaly (74.4%), followed by splenomegaly (66.7%). The majority of patients had at least three areas of abdominopelvic lymphadenopathy (71.8%). Pelvic lymphadenopathy was most commonly seen when eschar was found in the ipsilateral lower extremity (left, n = 5/7; right, n = 8/13). Significant association between hepatic dysfunction and perigastric lymphadenopathy was documented (p = 0.03).
  
  
  CONCLUSIONS
  Scrub typhus has a spectrum of variable clinical and radiological findings mimicking those of acute hepatitis. Diffuse abdominopelvic lymphadenopathy involving the retroperitoneum and pelvic area may aid in early diagnosis of scrub typhus. Perigastric lymphadenopathy could be a sign of severe scrub typhus combined with hepatic dysfunction.
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.
authors.forename: Kun Yung
authors.initials: KY
authors.lastname: Kim
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea. pichgo@gmail.com.|Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea. pichgo@gmail.com.|Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea. pichgo@gmail.com.
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Song
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.|Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.|Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
authors.forename: Eun Hae
authors.initials: EH
authors.lastname: Park
authors.affiliation: Department of Radiology, Chonbuk National University Medical School and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju, Chonbuk, 54907, Korea.|Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.|Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
authors.forename: Gong Yong
authors.initials: GY
authors.lastname: Jin
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology; D012189:Retrospective Studies; D012612:Scrub Typhus / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
keywords: Computed tomography; Lymphadenopathy; Orientia tsutsugamushi; Rickettsia tsutsugamushi; Scrub typhus