Inhalation Anthrax - MedPix™ Patient: 4153

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Clinical Presentation: 43 y.o. man

History

Postal worker with flu-like symptoms.

Physical Examination and Laboratory

Specific exam and lab values were not avaiable.

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Inhalation Anthrax

Patient A - Day 4

Patient A - Day 7

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Summary of Findings & Images

Chest Radiograph, Patient A, Day 4: Widened mediastinum with medistinal adenopathy, hilar fullness and small bilateral pleural effusions.

CT (noncontrast), Patient A, Day 4: Confirmed the hilar and mediastinal adenopathy, particularly subcarinal adenopathy, and small bilateral pleural effusions.

CT (IV contrast), Patient A, Day 5: Interval enlargement of the adenopathy and increased pleural effusion to approximately 60% of his chest volume. With the use of IV contrast in this study, the adenopathy shows enhancement and the central necrotic center is well demonstrated consistent with hemorrhagic adenpathy.

Differential Diagnosis

Malignant neoplasm
Aggressive Infection

Diagnosis: Inhalation Anthrax

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Treatment and Followup

Tx and Followup:
Both patients recieved IV antibiotic therapy.

Additional Discussion:
Two patients presented 4 days after exposure to inhalation anthrax. Inital examinations demponstrated massive medistinal adenopathy and small bilateral pleural effusions. The follow up CT examination on Patient A demonstrates enlargement of the adenopathy and increased pleural effusion to approximately 60% of the chest volume. With the use of IV contrast in this study, the adenopathy shows enhancement and the central necrotic region is well demonstrated - consistent with hemorrhagic adenpathy. This patient also had airspace disease which is non specific. However, in autopsy cases inhalation anthrax was shown to have focal hemorrhagic necrotizing pneumonic lesions.

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Contributor Credits

Submitted by: Maria Flynn -
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