Radiological manifestations of epidemic hemorrhagic fever

Kim, C Y; Bahk, Y W

Abstract

Epidural hemorrhagic fever, first described in the far eastern area of the Soviet Union in the 1930's, is anacute disease characterized by fever, malaise, vomiting, hemorrhagic manifestations, shock and renal failure. Theendemic area includes far eastern Siberia, eastern part of Manchuria and Korea north of Seoul. This disease was known in Korea already before 1951 when the first English report was published by Takami of the US Army. He reported on seasonal endemic occurance of the disease among the UN troops in Korea. A few years later, fullacounts of the disease were given in the form of symposium. Since then there have appeared numerous publication son epidemic hemorrhagic fever in Korea as well as in western countries, but radiological manifestations of the disease has received little attention. Inasmuch as there is as yet no specific test for this disease, anysubstantial diagnostic information is to be searched. In the present study, we have analysed radiological findings of the simple chest and flat abdomen x-rays which were secured as a part of routine tests in patients with this disease. The study was concentrated on the oliguric phase of the disease when pathological changes culminate. Inaddition, intensity and incidence of radiological changes were correlated to blood urea nitrogen and serum creatinine levels. Clinical materials consisted of 50 patients of both sexes seen at the Department of Radiology, St. Mary's Hospital, Seoul, and St. Vencent Hospital Suwon, Catholic Medical College, during the period of 2 years from January 1969. Chest x-ray findings were lung congestion (38%), lung edema (6%), cardiomegaly (16%), pleuralreaction (24%), and elevation of the diaphragm (8%). Radiological findings shown by plain film of abdomen were paralytic ileus (66%), obliteration of the psoas muscle shadows (60%), obliteration of the kidney shadows (32%), enlargement of the kidney (10%), and obliteration of the hepatic angle and/or widening of the flank stripe (60%).These findings represent wide spread hemorrhagic congestion of lung, pleura, heart, kidneys and peritoneum, andappear rather characteristic of epidemic hemorrhagic fever. Involvement of both peritoneal and retroperitoneal cavities appears to be of particular diagnostic value. Intensity and incidence of both thoracic and abdominalx-ray manifestations showed no significant correlation with blood urea nitrogen and serum creatinine levels,except the cardiac enlargement and obliteration of renal shadow which accompany most prominent increase in BUN and creatinine levels.