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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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
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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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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.
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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
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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
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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
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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