Pneumonia Pattern Identified on CT of MERS Patients

Computed tomography (CT) images have shown bilateral subpleural and basilar airspace changes in the lungs of people affected by Middle East respiratory syndrome (MERS), a severe illness with a high mortality rate, according to a study published online ahead of print in the American Journal of Roentgenology.

Researchers from Saudi Arabia performed a retrospective review to determine if there were noticeable changes in the lungs of MERS-confirmed patients who had undergone CT imaging. Seven patients were identified – five men, two women, with a median age of 50. Three patients died while in ICU. Imaging was performed on one patient on day of admission. The remaining six underwent CT imaging between one and 35 days, median 11 days.

The image findings were reviewed by two independent radiologists. They noted that the images showed bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. Airspace opacities were more common than interstitial changes among all patients. “Five of the seven patients had both ground-glass opacities and consolidation,” the authors wrote. “In those five patients, ground-glass opacities were more extensive than consolidation, with the exception of one patient. One of the seven patients had isolated ground-glass opacities and another had isolated consolidation.”

"A few studies have described variable degrees of lung opacities in patients with MERS, but did not clearly address their exact distribution," co-author Amr M. Ajlan said in a release. "Because we evaluated the CT findings in this laboratory-confirmed group of MERS patients, we had the ability to better characterize the nature and distribution of the abnormalities."

The authors noted that the patterns of MERS coronavirus infection are suggestive of an organizing pneumonia pattern.

Recognizing this pattern in acutely ill patients living in or traveling from endemic areas may help in the early diagnosis of MERS, although more study is needed, the authors concluded.