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Radiology. Emerging H7N9 Influenza A (Novel Reassortant Avian-Origin) Pneumonia: Radiologic Findings

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  • Radiology. Emerging H7N9 Influenza A (Novel Reassortant Avian-Origin) Pneumonia: Radiologic Findings

    [Source: Radiology, full page: (LINK). Abstract, edited.]
    Emerging H7N9 Influenza A (Novel Reassortant Avian-Origin) Pneumonia: Radiologic Findings

    Qingle Wang, MD, Zhiyong Zhang, MD, PhD, Yuxin Shi, MD, PhD and Yebin Jiang, MD, PhD<SUP>1</SUP>

    From the Department of Radiology, Shanghai Public Health Clinical Center, Shanghai Medical College of Fudan University, Shanghai 201508, China.

    Address correspondence to Z.Z. (e-mail:

    Author contributions: Guarantors of integrity of entire study, all authors; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, Y.S., Y.J.; clinical studies, all authors; and manuscript editing, Y.S., Y.J.



    To determine the radiologic findings of human infection with a novel reassortant avian-origin influenza A H7N9 virus in March 2013, the first outbreak in humans.

    Materials and Methods:

    The institutional review board approved this retrospective study. Twelve patients (nine men and three women) with novel avian-origin influenza A H7N9 virus infection were enrolled. All patients underwent chest radiography and thin-section computed tomography (CT). Lesion patterns, distributions, and changes at follow-up CT were investigated. Two chest radiologists reviewed the images and clinical data together and reached decisions concerning findings by consensus.


    At presentation, all patients had progressing infection of the lower respiratory tract, with fever, cough, and shortness of breath, which rapidly progressed to acute respiratory distress syndrome. The imaging findings included ground-glass opacities (GGOs) (in 12 of 12 patients), consolidations (in 11 patients), air bronchograms (in 11 patients), interlobular septal thickening (in 11 patients), centrilobular nodules (in seven patients), reticulations (in seven patients), cystic changes (in four patients), bronchial dilatation (in three patients), and subpleural linear opacities (in three patients). The lung lesions involved three or more lobes in all cases and were mostly detected in the right lower lobe (in 11 patients). Follow-up CT in 10 patients showed interval improvement (in three patients) or worsening (in seven patients) of the lesions. Imaging findings closely mirrored the overall clinical severity of the disease.


    Rapidly progressive GGOs and consolidations with air bronchograms and interlobular septal thickening, with right lower lobe predominance, are the main imaging findings in H7N9 pneumonia. The severity of these findings is associated with the severity of the clinical presentation.

    ? RSNA, 2013


    Received April 29, 2013; revision requested May 10; revision received May 24; accepted May 28; final version accepted May 29.

    1 Current address: Cancer Center, University of Michigan, Ann Arbor, Mich.


    ARDS = acute respiratory distress syndrome

    GGO = ground-glass opacity