HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Earls, J. P. Articles by Urban, B. Search for Related Content PubMed PubMed Citation Articles by Earls, J. P. Articles by Urban, B.

Inhalational Anthrax after Bioterrorism Exposure: Spectrum of Imaging Findings in Two Surviving Patients¹

¹ From the Departments of Radiology (J.P.E., D.C., E.B., B.U.) and Emergency Medicine (C.M., D.P., T.M.), INOVA Fairfax Hospital, Falls Church, Va; Fairfax Radiological Consultants, 2722 Merrilee Dr, Fairfax VA 22031 (J.P.E., D.C., E.B., B.U.); and Departments of Infectious Disease (J.R., N.F., S.B.M.) and Pulmonary Medicine (P.P.W., R.C.), Mid-Atlantic Permanente Medical Group, Kaiser Permanente, Fairfax, Va. Received November 16, 2001; revision requested November 19; revision received November 25; accepted November 27. Address correspondence to J.P.E. (e-mail: jpearls@yahoo.com).

View larger version (98K): [in a new window]   Figure 1. Case 1. Initial posteroanterior (left) and lateral (right) chest radiographs depict a minimally widened mediastinum with right paratracheal fullness (arrow), bilateral hilar enlargement (arrowheads), small bilateral pleural effusions, and subtle left lower lobe air-space disease. (Reprinted, with permission, from reference 11.)

View larger version (78K): [in a new window]   Figure 2a. Case 1. Initial transverse CT images. (a) Widespread hyperattenuating adenopathy. The largest lymph node (arrow) is in the subcarinal region. (Reprinted, with permission, from reference 11.) (b) There is also edema of mediastinal fat (arrowheads), (c) bilateral moderate-sized pleural effusions, bibasilar air-space disease, and (d) peribronchial thickening (arrows).

View larger version (84K): [in a new window]   Figure 2b. Case 1. Initial transverse CT images. (a) Widespread hyperattenuating adenopathy. The largest lymph node (arrow) is in the subcarinal region. (Reprinted, with permission, from reference 11.) (b) There is also edema of mediastinal fat (arrowheads), (c) bilateral moderate-sized pleural effusions, bibasilar air-space disease, and (d) peribronchial thickening (arrows).

View larger version (118K): [in a new window]   Figure 2c. Case 1. Initial transverse CT images. (a) Widespread hyperattenuating adenopathy. The largest lymph node (arrow) is in the subcarinal region. (Reprinted, with permission, from reference 11.) (b) There is also edema of mediastinal fat (arrowheads), (c) bilateral moderate-sized pleural effusions, bibasilar air-space disease, and (d) peribronchial thickening (arrows).

View larger version (107K): [in a new window]   Figure 2d. Case 1. Initial transverse CT images. (a) Widespread hyperattenuating adenopathy. The largest lymph node (arrow) is in the subcarinal region. (Reprinted, with permission, from reference 11.) (b) There is also edema of mediastinal fat (arrowheads), (c) bilateral moderate-sized pleural effusions, bibasilar air-space disease, and (d) peribronchial thickening (arrows).

View larger version (110K): [in a new window]   Figure 3a. Case 1. Serial frontal radiographs. (a) Effusions and air-space disease increased dramatically over the initial several days. (b) Radiograph obtained on hospital day 19 appears near normal, with the exception of small bilateral effusions.

View larger version (124K): [in a new window]   Figure 3b. Case 1. Serial frontal radiographs. (a) Effusions and air-space disease increased dramatically over the initial several days. (b) Radiograph obtained on hospital day 19 appears near normal, with the exception of small bilateral effusions.

View larger version (129K): [in a new window]   Figure 4a. Case 1. Follow-up transverse CT scans. (a) Effusions were considerably larger and filled more than 50% of each thoracic cavity on hospital day 4. (b) Mediastinal nodes also increased in size, and a hyperattenuating blood clot (arrow) in the left pleural space could be seen on hospital day 9. (c) Subcarinal and left hilar nodes remained enlarged on hospital day 19 despite substantial clinical improvement.

View larger version (128K): [in a new window]   Figure 4b. Case 1. Follow-up transverse CT scans. (a) Effusions were considerably larger and filled more than 50% of each thoracic cavity on hospital day 4. (b) Mediastinal nodes also increased in size, and a hyperattenuating blood clot (arrow) in the left pleural space could be seen on hospital day 9. (c) Subcarinal and left hilar nodes remained enlarged on hospital day 19 despite substantial clinical improvement.

View larger version (81K): [in a new window]   Figure 4c. Case 1. Follow-up transverse CT scans. (a) Effusions were considerably larger and filled more than 50% of each thoracic cavity on hospital day 4. (b) Mediastinal nodes also increased in size, and a hyperattenuating blood clot (arrow) in the left pleural space could be seen on hospital day 9. (c) Subcarinal and left hilar nodes remained enlarged on hospital day 19 despite substantial clinical improvement.

View larger version (129K): [in a new window]   Figure 5. Case 2. Initial portable anteroposterior chest radiograph shows widened mediastinum, right hilar mass (arrow), right pleural effusion, and right perihilar air-space disease. (Reprinted, with permission, from reference 11.)

View larger version (106K): [in a new window]   Figure 6a. Case 2. Initial nonenhanced transverse helical chest CT scans. (a) Enlarged hyperattenuating right hilar (lateral arrow) and azygoesophageal recess (medial arrow) adenopathy are shown. (b) Edema of mediastinal fat and bilateral pleural effusions are present. (c) Peribronchial thickening and air-space disease are more severe than in case 1.

View larger version (121K): [in a new window]   Figure 6b. Case 2. Initial nonenhanced transverse helical chest CT scans. (a) Enlarged hyperattenuating right hilar (lateral arrow) and azygoesophageal recess (medial arrow) adenopathy are shown. (b) Edema of mediastinal fat and bilateral pleural effusions are present. (c) Peribronchial thickening and air-space disease are more severe than in case 1.

View larger version (143K): [in a new window]   Figure 6c. Case 2. Initial nonenhanced transverse helical chest CT scans. (a) Enlarged hyperattenuating right hilar (lateral arrow) and azygoesophageal recess (medial arrow) adenopathy are shown. (b) Edema of mediastinal fat and bilateral pleural effusions are present. (c) Peribronchial thickening and air-space disease are more severe than in case 1.

View larger version (112K): [in a new window]   Figure 7a. Case 2. Follow-up frontal radiographs. (a) Pleural effusions and air-space disease increased dramatically by hospital day 4. (b) Right lower lobe air-space disease persisted on day 11. (c) The mediastinum appears near normal, but a right pleural effusion and air-space disease remained as of hospital day 17.

View larger version (126K): [in a new window]   Figure 7b. Case 2. Follow-up frontal radiographs. (a) Pleural effusions and air-space disease increased dramatically by hospital day 4. (b) Right lower lobe air-space disease persisted on day 11. (c) The mediastinum appears near normal, but a right pleural effusion and air-space disease remained as of hospital day 17.

View larger version (112K): [in a new window]   Figure 7c. Case 2. Follow-up frontal radiographs. (a) Pleural effusions and air-space disease increased dramatically by hospital day 4. (b) Right lower lobe air-space disease persisted on day 11. (c) The mediastinum appears near normal, but a right pleural effusion and air-space disease remained as of hospital day 17.

View larger version (136K): [in a new window]   Figure 8a. Case 2. Follow-up transverse CT scans. (a) A slightly larger but lower attenuation adenopathy (arrows) was seen by day 4. (b) Right pleural clot (arrow) was depicted on day 15.

View larger version (128K): [in a new window]   Figure 8b. Case 2. Follow-up transverse CT scans. (a) A slightly larger but lower attenuation adenopathy (arrows) was seen by day 4. (b) Right pleural clot (arrow) was depicted on day 15.

View larger version (73K): [in a new window]   Figure 9. Diagrammatic representation of current recommendations by the CDC for the evaluation of inhalational anthrax. Both chest radiographs and CT studies play a key role in the diagnosis of inhalational anthrax. (Reprinted, with permission, from reference 10.) The fifth bulleted item in the box marked "YES" should read "Consider chest computerized tomography (CT) if CR diagnosis is uncertain" (25).