Radiology of Influenza A (H1N1) by Hongjun Li & Ning Li

Author:Hongjun Li & Ning Li
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

Case 11.96

History of Present Illness. A 41-years-old man, complained of fever and cough for 4 days. He had fever 4 days ago, with a body temperature of 40 °C, with cough, no phlegm, sore extremities and fatigue. Therapies of ephalosporins and penicillin infusion showed no favorable outcomes in the local countryside clinic. Then he received oseltamivir therapy 1 day ago in the local hospital, with outcomes of chest tightness and the shortness of breath after activities. The patients was then transferred into the clinic of You’an Hospital in Beijing. On the fourth day after disease onset, he was hospitalized due to positive throat swabs.

Past History. The right collar bone fracture 10 years ago. No histories of other illnesses.

Contact History. Self reported none definitive history of contacting with Influenza A (H1N1) patients.

Signs. Body temperature 36.9 °C. Heart rate 92 beats/min. Respiration 23 times/min. Conscious but poor spirituality. No lips cyanosis. Tonsils not swollen. Respiration sound of the left middle lung low, with no dry and moist rales. Heart sound powerful with regular rhythm. No murmurs in the heart valvar areas.

Laboratory Tests

By throat swabs, universal gene of Influenza A virus (gene M) positive, universal gene of H1N1 swine flu (gene NP) positive, specific gene of Influenza A (H1N1) virus (gene HA) positive.

On Nov. 28th, 2009, routine blood tests found leukocytes count 4.1  ×  109/L, lymphocytes 46.10 % and neutrophils 38.30 %.

On Nov. 28th, 2009, HBV-M found HBsAb (+), and the other indices negative; HCVAb (−); syphilis (−).

On Nov. 29th, 2009, blood gas analysis found pH 7.379, PaO2 103 mmHg, PaCO2 39.8 mmHg, SaO2 98 %, 23.5 mmol/L, BE −2 mmol/L.

On Dec. 1st, 2009, subtypes of T-lymphocytes were CD4+ 816  ×  106/L, CD8+ 516  ×  106/L, CD4+/CD8+ 1.58.

Diagnostic Imaging

By chest CT scanning on Dec. 1st, 2009 (Fig. 11.96a–d), extensive cloudy flocculent shadows in both lungs; poor transparency of both lungs, especially the left lung; unsmooth bilateral pleura.

By chest CT scanning on Dec. 1st, 2009 (Fig. 11.96e–h), intrapulmonary patchy shadows with slightly increased density; blurry boundaries; uneven densities within shadows; obviously improved conditions compared to chest CT scanning on Nov. 28th, 2009.

Diagnosis. Pneumonia complicating Influenza A (H1N1).

Fig. 11.96

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