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Eur J Radiol Open . Influenza H1N1 virus-associated pneumonia often resembles rapidly progressive interstitial lung disease seen in collagen vascular diseases and COVID-19 pneumonia; CT-pathologic correlation in 24 patients

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  • Eur J Radiol Open . Influenza H1N1 virus-associated pneumonia often resembles rapidly progressive interstitial lung disease seen in collagen vascular diseases and COVID-19 pneumonia; CT-pathologic correlation in 24 patients


    Eur J Radiol Open


    . 2020 Nov 28;7:100297.
    doi: 10.1016/j.ejro.2020.100297. eCollection 2020.
    Influenza H1N1 virus-associated pneumonia often resembles rapidly progressive interstitial lung disease seen in collagen vascular diseases and COVID-19 pneumonia; CT-pathologic correlation in 24 patients


    Makiko Murota 1 , Takeshi Johkoh 2 , Kyung Soo Lee 3 , Tomas Franquet 4 , Yasuhiro Kondoh 5 , Yoshihiro Nishiyama 1 , Tomonori Tanaka 6 , Hiromitsu Sumikawa 7 , Ryoko Egashira 8 , Norihiko Yamaguchi 9 , Kiminori Fujimoto 10 , Junya Fukuoka 11 , Group of Creation of Radiological Paper from Japan in diffuse lung disease



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    Abstract

    Purpose: To describe computed tomography (CT) findings of influenza H1N1 virus-associated pneumonia (IH1N1VAP), and to correlate CT findings to pathological ones.
    Methods: The study included 24 patients with IH1N1VAP. Two observers independently evaluated the presence, distribution, and extent of CT findings. CT features were divided into either classical form (C-form) or non-classical form (NC-form). C-form included: A.) broncho-bronchiolitis and bronchopneumonia type, whereas NC-forms included: B.) diffuse peribronchovascular type, simulating subacute rheumatoid arthritis-associated (RA) interstitial lung disease (ILD) and C.) lower peripheral and/or peribronchovascular type, resembling dermatomyositis-associated ILD and COVID-19 pneumonia. In 10 cases with IH1N1VAP where lung biopsy was performed, CT and pathology findings were correlated.
    Results: The most common CT findings were ground-glass opacities (24/24, 100 %) and airspace consolidation (23/24, 96 %). C-form was found in 11 (46 %) patients while NC-form in 13 (54 %). Types A, B, and C were seen in 11(46 %), 4 (17 %), and 9 (38 %) patients, respectively. The lung biopsy revealed organizing pneumonia in all patients and 6 patients (60 %) showed incorporated type organizing pneumonia that was common histological findings of rapidly progressive ILD.
    Conclusion: In almost half of patients of IH1N1VAP, CT images show NC-form pneumonia pattern resembling either acute or subacute RA or dermatomyositis-associated ILD and COVID-19 pneumonia.

    Keywords: COVID-19; Computed tomography; Influenza A (H1N1) virus; Myositis and muscle disease; Pneumonia; Rheumatoid arthritis.

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