Hantavirus infection CT scan
|
Hantavirus infection Microchapters |
|
Patient Information |
|---|
|
Diagnosis |
|
Treatment |
|
Case Studies |
|
Hantavirus infection CT scan On the Web |
|
American Roentgen Ray Society Images of Hantavirus infection CT scan |
|
Directions to Hospitals Treating Hantavirus pulmonary syndrome |
|
Risk calculators and risk factors for Hantavirus infection CT scan |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Basir Gill, M.B.B.S, M.D.[2] Furqan M M. M.B.B.S[3]
Overview
On CT scan, hantavirus infection is characterized by ground-glass opacities, interlobular and intralobular septal thickening, and pleural effusions. In hantavirus cardiopulmonary syndrome (HCPS), chest CT findings correlate with non-cardiogenic pulmonary edema due to increased endothelial permeability.[1] In hemorrhagic fever with renal syndrome (HFRS), abdominal CT may reveal characteristic retroperitoneal changes including perirenal fascial thickening and fat stranding that may help suggest the diagnosis in the appropriate clinical setting.[2]
CT Scan
Hantavirus Cardiopulmonary Syndrome (HCPS)
Chest CT Findings
The usual findings on lung CT scans in HCPS during the cardiopulmonary phase are marked bilateral septal thickening, ground-glass opacities, and pleural effusions.[1] These findings reflect the underlying capillary leak syndrome with increased endothelial permeability and resultant non-cardiogenic pulmonary edema.[1]
Characteristic chest CT findings in HCPS include:[1][3]
Bilateral ground-glass opacities, most severe in the middle and lower lung zones
Smooth interlobular and intralobular septal thickening
Bilateral pleural effusions
Peribronchovascular thickening
Poorly defined small pulmonary nodules
Mosaic attenuation pattern
Increased pulmonary vascular diameters, particularly in the lower lobes
The Halo Sign
A halo sign — a pulmonary nodule surrounded by a rim of ground-glass opacity — has been described in HCPS. While classically associated with invasive fungal infections, in the context of hantavirus infection the halo sign represents virus-induced vascular injury and hemorrhagic changes rather than fungal disease.[4]
High-Resolution CT (HRCT) Findings
HRCT is more sensitive than chest radiography for detecting pulmonary involvement in hantavirus infection. In a study of 13 hospitalized patients with Puumala virus-induced nephropathia epidemica, 92% (12/13) showed lung parenchymal abnormalities on HRCT, compared with only 67% (8/12) on chest radiography. The most common HRCT findings were:[5]
Intralobular and interlobular septal thickening
Ground-glass opacification (seen in 31%)
Hilar and mediastinal lymphadenopathy (seen in 23%, a novel finding likely related to capillary leak and fluid overload)
The study concluded that while HRCT is more sensitive than chest radiography, the findings are not disease-specific and HRCT is most useful for research purposes or when clinical suspicion is high and chest radiographs are unrevealing.[5]
Cardiopulmonary Involvement in Puumala Virus Infection
In a prospective study of 27 hospitalized patients with Puumala virus infection, HRCT showed thoracic effusions or pulmonary edema in 46% of patients. Gas diffusing capacity was impaired in most patients during the acute phase, significantly improving at follow-up but remaining subnormal in 38% at 3 months. These CT findings correlated with elevated pulmonary vascular resistance, secondary pulmonary hypertension, and right heart distress on echocardiography.[6]
Hemorrhagic Fever with Renal Syndrome (HFRS)
Chest CT Findings in HFRS
More than half of patients with HFRS have respiratory symptoms such as hypoxia and radiological findings on CT scans.[1] In European series, more than half of patients with Puumala virus (PUUV) and Dobrava-Belgrade virus (DOBV) infections showed pathological pulmonary imaging with interstitial infiltrates and pleural effusions.[1] Pulmonary edema may occur during the oliguric phase, associated with hypertension and complications of renal insufficiency.[1]
Abdominal CT Findings in HFRS
Abdominal CT can provide important diagnostic clues in patients with suspected HFRS. In a retrospective study of 30 patients with serologically confirmed Puumala virus infection who underwent abdominal CT, the most frequent findings were:[2]
Perirenal fascial thickening (90%)
Perirenal fat stranding (87%)
Retroperitoneal fat stranding (64%), distributed in the perivesical spaces along the fascia of the external iliac vessels with or without involvement of the presacral fat
Pelvic ascites (50%)
Pleural effusion (23%)
Renal enlargement — mean pole-to-pole kidney length was 125.7 mm (right) and 127.8 mm (left)
Although these findings are nonspecific, the combination of retroperitoneal fat stranding, perirenal fascial thickening, and perirenal fat stranding may help suggest Puumala virus infection in the appropriate clinical setting.[2]
Classic Radiologic Features of HFRS
In a classic radiologic study of 62 patients with HFRS, abnormal findings were seen in 94% of patients on plain abdominal imaging and in 63% on chest imaging. The most significant finding was obliteration and blurring of anatomical detail in both intra- and retroperitoneal cavities with renal enlargement. The simultaneous presence of edema and effusion in both intra- and retroperitoneal cavities along with renal enlargement is considered practically pathognomonic of HFRS. Obliteration of the renal outline and cardiomegaly with overt pulmonary edema was associated with the most severe renal dysfunction.[7]
Sequelae of HFRS detectable by imaging include hemorrhage, acute renal failure, retroperitoneal edema, pancreatitis, pulmonary edema, and neurologic complications.[8]
Summary of CT Findings by Syndrome
| CT Finding | HCPS | HFRS |
|---|---|---|
| Ground-glass opacities | Very common, bilateral, middle and lower zones | Less common; seen in minority on HRCT |
| Interlobular/intralobular septal thickening | Prominent, smooth | Present, especially on HRCT |
| Pleural effusions | Common | Common (23–50%) |
| Peribronchovascular thickening | Present | Less commonly reported |
| Halo sign | Described (hemorrhagic vascular injury) | Not typically reported |
| Perirenal fascial thickening/fat stranding | Not typical | Very common (87–90%) |
| Retroperitoneal fat stranding | Not typical | Common (64%) |
| Renal enlargement | Not typical | Common |
| Pelvic ascites | Not typical | Common (50%) |
| Mediastinal lymphadenopathy | Described in minority | Not commonly reported |
For representative CT and chest radiograph images of hantavirus cardiopulmonary syndrome showing bilateral ground-glass opacities, interlobular septal thickening, and pleural effusions, see Barros N, et al. Case 12-2020: A 24-Year-Old Man with Fever, Cough, and Dyspnea. N Engl J Med. 2020;382(16):1544–1553.[9]
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Vial PA, Ferrés M, Vial C, Valdivieso F, Mertz GJ, Godoy P (2023). "Hantavirus in humans: a review of clinical aspects and management". Lancet Infect Dis. 23 (9): e371–e382. doi:10.1016/S1473-3099(23)00128-7. PMID 37105214 Check
|pmid=value (help). - ↑ 2.0 2.1 2.2 Lebecque O, Falticeanu A, Mulquin N, Dupont M (2022). "Abdominal CT findings in Puumala hantavirus-infected patients". Abdom Radiol (NY). 47 (7): 2552–2559. doi:10.1007/s00261-022-03467-8. PMID 35441863 Check
|pmid=value (help). - ↑ Gasparetto EL, Davaus T, Escuissato DL, Marchiori E (2007). "Hantavirus pulmonary syndrome: high-resolution CT findings in one patient". Br J Radiol. 80 (949): e21–3. doi:10.1259/bjr/30339154. PMID 17267465.
- ↑ Hunter BR, Meza JM, Katz JN (2025). "Hantavirus cardiopulmonary syndrome". N Engl J Med. 392 (3): e5. doi:10.1056/NEJMicm2406553. PMID 39813117 Check
|pmid=value (help). - ↑ 5.0 5.1 Paakkala A, Järvenpää R, Mäkelä S, Huhtala H, Mustonen J (2012). "Pulmonary high-resolution computed tomography findings in nephropathia epidemica". Eur J Radiol. 81 (8): 1707–11. doi:10.1016/j.ejrad.2011.04.049. PMID 21600717.
- ↑ Rasmuson J, Lindqvist P, Sörensen K, Hedström M, Blomberg A, Ahlm C (2013). "Cardiopulmonary involvement in Puumala hantavirus infection". BMC Infect Dis. 13: 501. doi:10.1186/1471-2334-13-501. PMID 24160911.
- ↑ Bahk YW, Kim CY (1978). "Radiologic manifestations of epidemic haemorrhagic fever with renal syndrome". Br J Radiol. 51 (611): 847–50. doi:10.1259/0007-1285-51-611-847. PMID 30510.
- ↑ Bui-Mansfield LT, Cressler DK (2011). "Imaging of hemorrhagic fever with renal syndrome: a potential bioterrorism agent of military significance". Mil Med. 176 (11): 1327–34. doi:10.7205/milmed-d-11-00048. PMID 22165665.
- ↑ Barros N, McDermott S, Wong AK, Turbett SE (2020). "Case 12-2020: A 24-Year-Old Man with Fever, Cough, and Dyspnea". N Engl J Med. 382 (16): 1544–1553. doi:10.1056/NEJMcpc1916256. PMID 32294349 Check
|pmid=value (help).