TropMed Imaging UNHALU22Feb2013Student2

7/28/2019 TropMed Imaging UNHALU22Feb2013Student2

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MOST OF PEOPLE FAIL TO ACHIEVE

THEIR GOALS,NOT BECAUSE THEY DO NOT HAVE

ABILITY,

BUT THEIR LACK OF COMMITMENT.(Zig Ziglar, motivator)


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NICK VUJICIC


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HEE AH LEE


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HIROTADA OTOTAKE


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The Imaging on

Infectious Disease &Tropical Medicine

Andi Darwis

Junus BaanDept of Radiology Wahidin Sudirohusodo Hospital/

Faculty of Medicine Hasanuddin University

Makassar, INDONESIA


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http://localhost/var/www/apps/conversion/tmp/scratch_1/Tes%20Profesionalisme.ppt


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GROUPS OF ORGANISM

1. Bacterial

2. Granulomatous

3. Viral

4. Parasitic :

protozoal & metazoal

5. HIV/AIDS

TARGET ORGANS/SYTEMS

Most common:

Central nervous system

(CNS)

Respiratory systems

dWiz tropmed Imaging


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CNS INFECTION

- Life-threatening disease

- Routes:

1. Hematogenous dissemination

2. Direct extension

-Infectious agentare consideredpathologicwhen

a normal individual is infected by anadequate

inoculumsand opportunistic if thehost is

compromised



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CNS INFECTION

Including :

- Meningitis

- Cerebritis & Brain Abscess

- Encephalitis

Meningitis is the most common CNS infection

Imaging recommendation: CT & MRI



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MENINGITIS

May be normal early

Subarachnoid space,

pia enhance

Basal cisterns effaced

Complications:

HydrocephalusVentriculitis

Infarction



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ENCEPHALITIS

Diffuse, nonfocal

brain inflammation

Most (but not all)

caused by virus

Herpes

Can be acute orchronic



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PULMONARY INFECTION

Access the respiratory system and

cause infection by route:

Inoculation via the tracheobronchial treeby inhalation droplets

Aspiration of oropharyngeal secretions

Direct extension



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PULMONARY INFECTION

PatternPathologically:

Central airways [tracheobronchitis]

Small airways [bronchiolitis] parenchyma

Pneumonia: Lobar pneumonia

Bronchopneumonia

Interstitial pneumonia



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PULMONARY INFECTION

Lobar pneumonia involve the entire lobe of

the lung w/o bronchial involvement.

Bronchopneumonia first involve the bronchus

and then spreads to the alveoli.



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PULMONARY INFECTION

Imaging studies:

Chest X-Ray [CXR] usually sufficient for

clinical practice

CT more sensitive, will detect infection

an average 5 days before CXR abnormal



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PULMONARY INFECTION

Imaging findings Consolidation: Bacterial, fungal, mycobacterial

Nodule: Fungal, mycobacterial, nocardia

Linear or interstitial: PCP, viral

Associated features

Pleural effusion: Bacterial

Cavitation: Bacterial

Lymphadenopathy: Bacterial



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http://content.nejm.org/content/vol351/issue23/images/large/02f2.jpeg


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Viral pneumonia

nonspecific

Usually involves small airways

Bronchial wall thickening

Air trapping, or Subsegmental atelectasis

Variable radiographic pattern

Diffuse interstitial thickening or

patchy consolidation

Focal air-space opacitiesuncommon

Avian Influenza



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Avian Influenza

Radiographs from Patient 1 (A), Patient 2 (B), and Patient 3 (C) show widespread consolidation,collapse, and interstitial shadowing. In Panels D, E, and F, three chest radiographs show the

progression in Patient 4 on days 5, 7, and 10 of illness, respectively.

http://content.nejm.org/content/vol350/issue12/images/large/06f3.jpeg


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Viral pneumonia



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HIV/AIDS

30% of ptx w/ AIDS have neurologic Cx Clinical findings should guide imaging stx

[NOT REVERSE]

Most common imaging findings:

white matter disease + atrophy



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HIV encephalopathy Multifocal nonenhancing WM hyperintensities

Diffuse cerebral & cerebellar atrophy

Opportunistic infection Toxoplasmosis: ring-enhancing mass[es] basal ganglia

Cryptococcosis: meningoencephalitis

CMV: encephalitis, ventriculitis

Lymphoma: solitary or multifocal lesions; solid or ring-

enhancing at deep [basal ganglia, periventricular]

HIV/AIDS



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Normal Brain

dWiz Geriatric ImagingdWiz tropmed Imaging


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HIV/AIDS



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HIV/AIDS



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HIV positive in a 23 yo woman withfever & head-ache



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CT scan 5 months after therapy of toxoplasmosis



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Manifestation in other organ/system include:

Respiratory tract

GI tract

Bone

HIV/AIDS



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Manifestation in respiratory tract Pneumocystic carinii pneumonia (PCP)

Associated w AIDS or immunocompromised host

CXR :

Perihilar ground-glass opacity

Air-space consolidation may be seen

Pneumatoceles may develop

CT is highly sensitive

Ground-glass opacity visible in all ptx

HIV/AIDS



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HIV/AIDS



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PCP


HIV/AIDS


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HIV/AIDS



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Malaria

Imaging studies:

Respiratory symptomsCXR

SplenomegalyUS

CNS symptomsCT or MR



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Dengue Hemorrhagic Fever

Imaging study: Chest X-ray

CXR-RLDpleural effusion is typical.

Bilateral pleural effusions are common

in patients with DSS



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Pleural effusion



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Varicella

May cause pneumonia &

central nervous system deficits.

Imaging studies: Chest X-ray.

MRI may be useful if suspicion of

myelitis or encephalitis exists



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Varicella



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Mumps

Imaging may be needed for

complicated cases involving

certain organ systems.

Parotitis

OrchitisMeningoencephalitis



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Cytomegalovirus

CMV pneumonia can be suggested by

chest radiograph findings

CT scan is more sensitive for theidentification of infiltrate

CMV may cause aseptic meningitis,

encephalitis can be detected by

CT and or MRI



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CMV Ventriculitis withperiventricular enhancement (Owls eyes) Acute CMV Pneumonia



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TETANUS

Imaging studies of the head and spinereveal no abnormalities.

Severe tetanus with opisthotonos,

results in over flexion of the spine

which can produce a multi-segment of

anterior wedging compression fracture

of the spine.



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Ascariasis


CXR may show fleeting opacities duringpulmonary migration

Plain abdomen may show

A whirlpool pattern of intraluminal worms. Narrow-based air fluid levels without distended

loops of bowel on upright plain films suggest

partial obstruction.

Wide-based air fluid levels with distended loops

suggest complete obstruction.


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Small bowel obstruction

caused by ascariasis.Eosinophilic Loeffler infiltrate



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Tuberculosis

CXR may show normal findings

Lung TB divided into

Primary TB : consolidation, patchy,lymphadenopathy, & pleural effusion

Reactivation TB : cavitation in upper lobe

Minimal/no response to therapy

considered AIDS or drug resistant



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Tuberculosis

CNS involvement need CT and or MRI

Two different but related processes:

Meningitis TB basilar meningitis

Tuberculoma:

Solitary or multiple Solid or rim-enhancement



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Primary complex Cavitating apical tuberculosis



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Cavitating tuberculosis Miliary tuberculosis



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Brain TB



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Brain TB



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Spondylitis TB


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Spondylitis TB


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Spondylitis TB


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Leprosy

Characterized by localized skin lesion

Nerve involvement leads to skin anesthesia,

muscle atrophy and autoamputation of digits

Musculoskeletal abnormalities plain film :

- Osseous changes usually confined to face & feet

- Distal and proximal phalangeal resorption



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Anthrax

Most common in agricultural country Contact w/ tissues animals

Three form

Cutaneous

Gastrointestinal

Inhalational

Inhalational anthrax occurs when

spore-containing dust is inhaled



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Anthrax

CXR widening of the mediastinum

progressively pleural effusions

lung opacity is usually minimal

CT scan for early detection of

enlargement of lymph nodes

peribronchial thickening

edema, or pleural effusions.

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Severe acute respiratory syndrome (SARS)

SARS is a serious, potentially life-threatening

viral infection

Caused by a previously unrecognized virus

from the Coronaviridae family

Serial CXR can be used to monitor and

evaluate patient progress

The role of HRCT is still controversial.



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SARS - CXR

Initial CXR abnormal in approx. 60% of ptx.

Abnormalities observed in in nearly all ptx by

10-14 days after symptom onset

Early stage a peripheral, pleural-based opacity

(ground-glass opacification to frank consolidation)

or interstitial infiltrates

Calcification, cavitation, pleural effusion, or

lymphadenopathy is NOT OBSERVED in SARS



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SARS - CT

Ptx w/ strong clinical possibility SARS,

if CXR finding is normalconsider CT

Findingsground-glass opacification, w/ or

w/out thickening of the intralobular interstitium

or interlobular interstitium, frank consolidation



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Toxocariasis

In a patient with pulmonary involvement,chest radiograph may show multiple nodules

with surrounding ground-glass opacities, or

possibly pleural effusion.

Ultrasonography reveals multiple hypoechoic

areas in the liver.



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Toxocariasis

CT scan Hepatic lesions are of low density.

Pulmonary involvement manifests with multiple

nodules and surrounding ground-glass opacities,or rarely, pleural effusion.

In the CNS, granulomas appear cortically or

subcortically, showing a hyperintense appearanceon proton density and T2-weighted images.



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If we are soft to ourselves today,the world will be harder to us in

the future.But, if we are hard to ourselvestoday, the world will be softer

to us in the future.


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Daftar Pustaka

1. David Sutton & Jeremy W.R.Young.A Concise Textbook of Clinical Imaging, 2nd ed.

Mosby, 1995.

2. Grainger & Allison. Diagnostic Radiology, 4th ed.

Churchill-Livingstone, 2002.

3. Wilfred Peh. The Asian-Oceanic Textbook of

Radiology, 2003.

4. W. Richard Webb & Charles B. Higgins.

Thoracic Imaging. Lippincott William & Wilkin, 2005

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TropMed Imaging UNHALU22Feb2013Student2