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Initial chest X-ray findings in pediatric patients diagnosed with H1N1 virus infection

Isa Félix Adôrno, Tiago Kojun Tibana, Rômulo Florêncio Tristão Santos, Victor Machado Mendes Leão, Yvone Maia Brustoloni, Pedro Augusto Ignácio Silva, Marco Antônio Ferreira, Thiago Franchi Nunes
Radiologia Brasileira 2019, 52 (2): 78-84

Objective: To evaluate chest X-ray findings in pediatric patients diagnosed with influenza A (H1N1) virus infection.

Materials and Methods: We retrospectively reviewed chest X-ray findings in 17 cases of pulmonary infection with the H1N1 virus (in 7 males and 10 females) examined between 2012 and 2016. The mean age of the patients was 14 months (range, 2-89 months). The diagnosis was established on the basis of clinical and radiographic criteria, and the virus was detected by polymerase chain reaction. The radiographic findings were categorized by type/pattern of opacity and by lung zone. The patients were divided into two groups: those not requiring ventilatory support; and those requiring ventilatory support or evolving to death.

Results: The abnormality most often seen on chest X-rays was that of peribronchovascular opacities, the majority of which affected less than 25% of the lung, the involvement being bilateral and asymmetric. The lung zone most frequently involved was the middle third, with central and peripheral distribution, without pleural effusion. There was a statistically significant difference between the groups in terms of the symmetry of pulmonary involvement, asymmetric findings predominating in the group that required ventilatory support ( p = 0.029).

Conclusion: In pediatric patients with H1N1 virus infection, the main alterations on the initial chest X-rays are peribronchovascular opacities, nonspecific alveolar opacities, and consolidations. Although the definitive diagnosis of H1N1 virus infection cannot be made on the basis of imaging characteristics alone, using a combination of clinical and radiographic findings can substantially improve the diagnostic accuracy.


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