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Eye of the Storm: The Roles of a Radiology Department in the Outbreak of Severe Acute Respiratory Syndrome

S. S. Y. Ho1, P. L. Chan1, P. K. Wong1, G. E. Antonio1, K. T. Wong1, D. J. Lyon2, K. S. C. Fung2, C. K. Li3, A. F. B. Cheng2 and A. T. Ahuja1

1 Department of Diagnostic Radiology and Organ Imaging, Prince of Wales Hospital, 30-32 Ngan Shing St., Shatin, New Territories, Hong Kong, China.
2 Department of Microbiology, Prince of Wales Hospital, Hong Kong, China.
3 Department of Pediatrics, Prince of Wales Hospital, Hong Kong, China.



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  		Fig. 1. —Chest radiograph of 21-year-old woman shows common manifestation of severe acute respiratory syndrome. Note ill-defined air-space opacity in right lower zone and absence of pleural effusion, cavitation, or lymphadenopathy.

 


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  		Fig. 2. —High-resolution CT scan of 29-year-old man shows common manifestation of severe acute respiratory syndrome. Note multiple areas of peripheral ground-glass opacification, some with superimposed thickened interlobular septa.

 


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  		Fig. 3A. —25-year-old male health care worker, strongly suspected clinically of having severe acute respiratory syndrome. Frontal chest radiograph shows no abnormality.

 


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  		Fig. 3B. —25-year-old male health care worker, strongly suspected clinically of having severe acute respiratory syndrome. High-resolution CT scan shows consolidation in paraspinal aspect of left lower lobe.

 


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  		Fig. 4. —Tree diagram shows imaging protocol for patients suspected of having severe acute respiratory syndrome (SARS). Note that initial findings on chest radiography may be negative or questionable in this disease and that pulmonary abnormalities could only be revealed or confirmed on CT.

 


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  		Fig. 5. —Tree diagram shows imaging protocol for patients with severe acute respiratory syndrome (SARS). Note that disease progression or resolution of SARS is better visualized on CT for retrocardiac, paraspinal, or posterior costophrenic angle pulmonary abnormalities.

 


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  		Fig. 6A. —27-year-old woman with clinical findings of severe acute respiratory syndrome. Frontal chest radiograph obtained on admission (day 1) shows bilateral lower zone peripheral opacification, which is worse on left.

 


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  		Fig. 6B. —27-year-old woman with clinical findings of severe acute respiratory syndrome. Radiograph obtained on day 2 shows increased bilateral patchy opacification, spreading centrally and to mid zone. Opacification is more extensive on left with tendency toward confluence.

 


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  		Fig. 6C. —27-year-old woman with clinical findings of severe acute respiratory syndrome. Radiograph obtained on day 4 shows increased opacification in both lungs, which is worse on left.

 


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  		Fig. 6D. —27-year-old woman with clinical findings of severe acute respiratory syndrome. Radiograph obtained on day 14 shows almost complete resolution of opacities. Patient was discharged after radiograph was obtained.

 


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  		Fig. 7A. —33-year-old woman with clinical findings of severe acute respiratory syndrome. High-resolution CT scan (1-mm thickness) obtained on day 2 after admission shows small area of consolidation in inferior lingular segment (arrow) between major fissure and heart.

 


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  		Fig. 7B. —33-year-old woman with clinical findings of severe acute respiratory syndrome. High-resolution CT scan obtained at same level on day 17 shows slightly larger area of involvement in inferior lingular segment and new areas of ground-glass opacification in right lower lobe.

 

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