Severe Acute Respiratory Syndrome: Radiographic Review of 40 Probable Cases in Toronto, Canada

PURPOSE: To review radiographic findings of patients with probable severe acute respiratory syndrome (SARS) who were seen at a University of Toronto (Ontario, Canada) teaching hospital.

MATERIALS AND METHODS: Findings were reviewed for 40 patients who fulfilled the World Health Organization criteria for probable SARS. A template was designed for the analysis of each serial radiograph to observe patterns and distribution of disease, interval changes, and complications. The majority of radiographs were anteroposterior views. A clinical database of these patients was also collected for clinical-radiologic comparison.

RESULTS: The mean age of the patients (18 male, 22 female) was 42.7 years. Patients had a normal chest radiograph and focal, multifocal, and/or bilateral consolidation. The pattern of consolidation tended to be peripheral and poorly marginated and involved middle and lower lung zones. The serial sequence fell into two major subgroups, which correlated closely with clinical outcome. Consolidation in one group cleared within a matter of days, while the second group went on to develop rapid and extensive bilateral pneumonia, with a prolonged hospital stay. Subsegmental atelectasis and pleural complications were rarely observed.

CONCLUSION: SARS pneumonia can manifest as focal peripheral consolidation that clears relatively quickly and does not cause secondary complications or that progresses to bilateral consolidation and a more protracted clinical course.

© RSNA, 2003

References

  • 1 Drazen JM. Case clusters of the severe acute respiratory syndrome. N Engl J Med [serial online]. 2003; Available at: content.nejm.org/cgi/content/abstract/NEJMe030062v2. Accessed April 22 2003.
  • 2 Update: outbreak of severe acute respiratory syndrome—worldwide, 2003.MMWR Morb Mortal Wkly Rep2003; 52:226-228.
  • 3 Update: Severe acute respiratory syndrome—United States, 2003.MMWR Morb Mortal Wkly Rep2003; 52:357-360.
  • 4 Severe acute respiratory syndrome (SARS).Wkly Epidemiol Rec2003; 78:81-83.
  • 5 World Health Organization. Severe acute respiratory syndrome (SARS). Available at: www.who.int/csr/sars/. Accessed April 23 2003.
  • 6 Poutanen SM, Low DE, Henry B, et al. Identification of severe acute respiratory syndrome in Canada. N Engl J Med [serial online]. 2003; Available at: content.nejm.org/cgi/reprint/NEJMoa030634v3.pdf. Accessed April 23 2003.
  • 7 Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the Greater Toronto Area. JAMA [serial online]. 2003; Available at: jama.ama-assn.org/cgi/content/full/289.21.JOC30885v1. Accessed May 13 2003.
  • 8 Kondro W. SARS virus claims its third victim in Canada. Lancet 2003; 361:1106.
  • 9 Health Canada. Active SARS cases in Canada. Available at: www.hc-sc.gc.ca/english/protection/warnings/sars/sars_numbers.html. Accessed April 26 2003.
  • 10 Centers for Disease Control and Prevention. Updated interim US case definition of severe acute respiratory syndrome (SARS). Available at: www.cdc.gov/ncidod/sars/casedefinition.htm. Accessed April 23 2003.
  • 11 Tsang KW, Ho PL, Ooi GC, et al. A cluster of cases of severe acute respiratory syndrome in Hong Kong. N Engl J Med [serial online]. 2003; Available at: content.nejm.org/cgi/reprint/NEJMoa030666v3.pdf. Accessed April 23 2003.
  • 12 Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med [serial online]. 2003; Available at: content.nejm.org/cgi/reprint/NEJMoa030685v2.pdf. Accessed April 23 2003.
  • 13 Hoey J. Severe acute respiratory syndrome. CMAJ 2003; 168:1013.
  • 14 Drosten C, Gunther S, Preiser W, et al. Identification of a novel virus in patients with severe acute respiratory syndrome. N Engl J Med [serial online]. 2003; Available at: content.nejm.org/cgi/reprint/NEJMoa030747v2.pdf. Accessed April 22 2003.
  • 15 Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med [serial online]. 2003; Available at: content.nejm.org/cgi/reprint/NEJMoa030781v4.pdf. Accessed April 22 2003.
  • 16 Peiris JS, Lai ST, Poon LL, et al. Coronavirus as a possible cause of severe acute respiratory syndrome. Lancet [serial online]. 2003; Available at: image.thelancet.com/extras/03art3477web.pdf. Accessed April 8 2003.
  • 17 Falsey AR, Walsh EE, Hayden FG. Rhinovirus and coronavirus infection-associated hospitalizations among older adults. J Infect Dis 2002; 185:1338-1341.
  • 18 Falsey AR, Walsh EE. Commentary: novel coronavirus and severe acute respiratory syndrome. Lancet [serial online]. 2003; Available at: image.thelancet.com/extras/03cmt87web.pdf. Accessed April 8 2003.
  • 19 El-Sahly HM, Atmar RL, Glezen WP, Greenberg SB. Spectrum of clinical illness in hospitalized patients with “common cold” virus infections. Clin Infect Dis 2000; 31:96-100.
  • 20 Riski H, Hovi T. Coronavirus infections of man associated with diseases other than the common cold. J Med Virol 1980; 6:259-265.
  • 21 Wenzel RP, Hendley JO, Davies JA, et al. Coronavirus infections in military recruits. Am Rev Respir Dis 1974; 109:621-624.
  • 22 Hamre D, Beem M. Virologic studies of acute respiratory disease in young adults. V. Coronavirus 229E infections during 6 years of surveillance. Am J Epidemiol 1972; 96:94-106.
  • 23 Hendley JO, Fishburne HB, Gwaltney JM. Coronavirus infections in working adults: eight year study with 229E and OC43. Am Rev Respir Dis 1972; 105:805-811.
  • 24 Folz RJ, Elkordy MA. Coronavirus pneumonia following autologous bone marrow transplantation for breast cancer. Chest 1999; 115:901-905.
  • 25 Wong KT, Antonio GE, Hui D, et al. Severe acute respiratory syndrome: radiographic appearances and pattern progression in 138 patients. Radiology 2003; 228:401-406.
  • 26 Wong KT, Antonio GE, Hui D, et al. Thin-section CT of severe acute respiratory syndrome: evaluation of 73 patients exposed to or with the disease. Radiology 2003; 228:395-400.

Article History

Published in print: Sept 2003