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High-Resolution CT Findings in Patients with Severe Acute Respiratory Syndrome: A Pattern-Based Approach

Monica S. M. Chan1, Ivan Y. F. Chan1, K. H. Fung1, Edwin Poon2, Loretta Y. C. Yam2 and K. Y. Lau1

1 Department of Radiology, Pamela Youde Nethersole Eastern Hospital, 3 Lok Man Rd., Chai Wan, Hong Kong, SAR China.
2 Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR China.



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  		Fig. 1. —Bar chart shows mean (white bars) and median (black bars) duration of symptoms (days) for different high-resolution CT (HRCT) features observed.

 


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  		Fig. 2. —High-resolution CT scan of thorax of 31-year-old woman with severe acute respiratory syndrome shows irregular well-defined areas of ground-glass opacity in both upper lobes.

 


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  		Fig. 3. —18-year-old man who presented with 3-day history of febrile illness and contact with patient with severe acute respiratory syndrome. Serial chest radiographs (not shown) showed no consolidation. High-resolution CT scan of thorax shows focal area of ground-glass opacity not reaching pleural surface in anterior segment of left upper lobe. Note lack of obliteration of bronchial and vascular markings.

 


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  		Fig. 4. —19-year-old woman who presented with febrile illness and right lower zone haziness on chest radiograph (not shown). She was later confirmed to have severe acute respiratory syndrome. High-resolution CT scan of thorax shows crazy paving pattern characterized by thin reticular shadow superimposed on ground-glass opacity in left upper lobe. Note lack of obliteration of bronchial and vascular markings and lack of architectural distortion.

 


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  		Fig. 5A. —52-year-old man who presented with persistent fever and diarrhea. He was later confirmed to have severe acute respiratory syndrome. Initial chest radiographs (not shown) showed no consolidation. High-resolution CT (HRCT) scan of thorax reveals coexistence of areas of ground-glass opacity (thin arrow) in left upper lobe and crazy paving pattern (thick arrow) in right middle and lower lobes.

 


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  		Fig. 6A. —35-year-old woman who completed treatment for severe acute respiratory syndrome but had persistent lower zone shadow on chest radiographs (not shown). High-resolution CT (HRCT) scan of thorax at mid atrial level shows sharp lines of demarcation (dotted lines) in areas affected by thin reticular shadow (thin white arrow) in superior lingular segment of left upper lobe and consolidation with air bronchogram (thick white arrow) in apical segment of left lower lobe. Note subpleural sparing (black arrow).

 


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  		Fig. 7. —69-year-old woman with history of travel to China in early February, who presented with diarrhea and fever and was later confirmed to have severe acute respiratory syndrome. High-resolution CT scan of thorax shows areas of marble shadow in bilateral upper lobes. Note inhomogeneous patchwork-like pattern.

 


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  		Fig. 6B. —35-year-old woman who completed treatment for severe acute respiratory syndrome but had persistent lower zone shadow on chest radiographs (not shown). HRCT scan of thorax shows pleural effusion (thin black arrow) along major fissure and thick reticular shadow with parenchymal opacification (thick black arrow) in apical segment of left upper lobe, thin reticular shadow (thick white arrow) in anterior segment of right upper lobe, and paraseptal emphysema (thin white arrow) in superior segment of right lower lobe.

 


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  		Fig. 6C. —35-year-old woman who completed treatment for severe acute respiratory syndrome but had persistent lower zone shadow on chest radiographs (not shown). HRCT scan of thorax obtained at level of right pulmonary artery depicts consolidation with air bronchogram showing traction bronchiolectasis (thin arrow) and consolidation without air bronchogram (thick arrow) in apical segment of left lower lobe.

 


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  		Fig. 8. —High-resolution CT scan of thorax in 48-year-old man with diabetes mellitus and severe acute respiratory syndrome shows extensive pneumomediastinum (thick white arrow) with subcutaneous emphysema. Note small pneumothorax (thin white arrow) on right side. Dense parenchymal band associated with pleural puckering (thick black arrow) was found at right lower lobe. Note presence of subpleural bleb associated with dense masslike organizing parenchymal densities (thin black arrow).

 


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  		Fig. 9. —66-year-old man with severe acute respiratory syndrome. High-resolution CT scan of thorax obtained on day 21 of illness shows thin linear shadows perpendicular to pleura, representing thickened interlobular septa (arrow) at right lung base. Note sharp demarcation between unaffected and affected lung (dotted line).

 


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  		Fig. 10. —High-resolution CT scan of thorax in 62-year-old woman with severe acute respiratory syndrome shows honeycomb shadow (arrow) in left lower lobe.

 


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  		Fig. 5B. —52-year-old man who presented with persistent fever and diarrhea. He was later confirmed to have severe acute respiratory syndrome. Initial chest radiographs (not shown) showed no consolidation. Follow-up HRCT scan of thorax obtained 3 weeks after A shows masslike organizing shadow (thin arrow) with traction bronchiolectasis and pleural puckering (thick arrow) in right lower lobe. These were not found in initial study (not shown).

 


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  		Fig. 11. —High-resolution CT scan of thorax in 19-year-old woman with severe acute respiratory syndrome shows band shadow (arrow) at right lower lobe.

 


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  		Fig. 12. —52-year-old man who recovered from severe acute respiratory syndrome. High-resolution CT scan of thorax obtained at early chronic phase shows residual increase in background density in previously affected areas (arrow). Note sharp line of demarcation (dotted line).

 

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