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Influenza A pneumonia

Case contributed by Dr Joachim Feger

Presentation

Admitted early March 2020, somewhere in the middle of nowhere in Germany with fever, dry cough and pleuritic pain, hypoxia and hypocapnia.

Patient Data

Age: 60 years
Gender: Female
X-ray

Mildly increased cardiothoracic ratio (CTR): 52%.

Patchy, bilateral infiltrates and airspace opacification predominantly in the mid and lower lung zones.

No visible pleural effusions.

 

CT

Thoracic CT

Findings:

Quality: suboptimal inspiration

Normal contrast in the pulmonary arteries. Coronary sclerosis.

No significant mediastinal lymphadenopathy.

Bilateral irregular consolidations along the bronchovascular bundles in the lower lobes and middle lobe, with air bronchograms.

Extensive patchy bilateral ground-glass opacities (GGO) with small consolidations again along and around the bronchovasular bundles and bronchial wall thickening.

Impression:

Bilateral ground-glass opacities (GGO) and consolidations suggestive of atypical pneumonia.

Annotated image

Key findings:

Irregular areas of consolidation along the bronchovascular bundles pronounced in middle and lower lobes (arrows).

Diffuse ground-glass opacities (GGO) again along and around the broncho-vascular bundles (red arrowheads), areas with interlobar thickening (blue arrowheads) and bronchial wall thickening (orange arrows).

Combinations of ground-glass opacities (GGO) and consolidation (blue arrows).

Case Discussion

This case illustrates and shows the most common findings of influenza A pneumonia a combination of multifocal ground-glass opacities (GGO) and irregular consolidations, mainly along and around the bronchovascular bundles.

Real-time polymerase chain reaction (PCR) after respiratory swab was positive for influenza A virus RNA.

The patient was put under isolation and received supportive and antiviral therapy (oseltamivir) and an antibiotic regimen covering for gram-positive cocci for 7 days. After a hospital course of 8 days, the patient recovered and was released home in a vastly improved condition.

Outpatient follow-up CT, three weeks later, was normal and showed complete resolution of the ground glass opacities (GGO) and consolidations.

This is also an important differential diagnosis for COVID-19 pneumonia.

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Case information

rID: 75217
Published: 22nd Mar 2020
Last edited: 6th Apr 2020
System: Chest
Inclusion in quiz mode: Included

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