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New imagining analysis defines H7N9 flu progression

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An x-ray and computed tomography analysis of the H7N9 influenza outbreak in China conducted by Dr. Zhiyong Zhang and colleagues from the Department of Radiology at the Shanghai Public Health Clinical Center and Shanghai Medical College of Fudan University in China published in the July 2, 2013, issue of the journal Radiology is the first to track the progression of H7N9 influenza to pneumonia.

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The study involved 12 patients (nine men and three women, 47 to 81 years of age) who were admitted to Shanghai Public Health Clinical Center between April 3, 2013, and April 20, 2013.

None of the patients raised pigeons or lived in or near an area that was known to have pigeons infected with H7N9. One patient kept chickens at home. Four patients had gone to farmers' markets before the onset of any flu symptoms. All other patients had no clear history of exposure to poultry.

All patients exhibited fever with temperature between 100 and 104 degrees Fahrenheit, cough, shortness of breath, white phlegm, and loss of strength at the onset of the disease or within one week. They rapidly progressed to severe pneumonia and acute respiratory distress syndrome.

The disease progression was monitored with x-rays and computed tomography (CT) scans regularly in each patient to document the disease progression.

“The imaging findings included ground-glass opacity (a hazy area in the lungs with the appearance of ground glass) in all 12 patients, consolidations (regions of lung tissue filled with liquid) in 11 patients, air bronchograms (air-filled bronchi made visible by swelling in adjacent tissues) in 11 patients, and interlobular septal thickening (thickening of pulmonary connective tissue) in 11 patients. Lung lesions involved three or more lobes in all cases, but were mostly detected in right lower lobe. Follow-up computed tomography (CT) in 10 patients showed interval improvement of the lesions in three patients and worsening of the lesions in seven patients. Imaging findings closely mirrored the overall clinical severity of the disease.”

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