Pandemic Influenza A (H1N1) 2009: Chest Radiographic Findings from 147 Proven Cases in the Montreal Area Alexandre Semionov, MD, Cécile Tremblay, MD,

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Pandemic Influenza A (H1N1) 2009: Chest Radiographic Findings from 147 Proven Cases in the Montreal Area Alexandre Semionov, MD, Cécile Tremblay, MD, Louise Samson, MD, Martin Chandonnet, MD, Jean Chalaoui, MD, Carl Chartrand- Lefebvre, MD Canadian Association of Radiologists Journal Volume 61, Issue 4, Pages 233-240 (October 2010) DOI: 10.1016/j.carj.2010.03.008 Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 1 A 27-year-old woman with known renal transplantation, presenting with fever, cough, shortness of breath, myalgia, and arthralgia. Isolated influenza A (H1N1) infection was confirmed by reverse-transcriptase polymerase chain reaction. (A) Postero-anterior (PA) chest radiograph at presentation, showing left lower lobe heterogeneous consolidation. Bilateral small pleural effusion is seen. There is a dialysis catheter. (B) PA chest radiograph on day 5, showing progression of the consolidation that involved the left lower lobe. Consolidation in the left upper lobe is now also seen. (C) Antero-posterior chest radiograph on day 9, revealing a new right lung base consolidation and progression of the left lung consolidations. An endotracheal tube and a left jugular catheter were placed. Canadian Association of Radiologists Journal 2010 61, 233-240DOI: (10.1016/j.carj.2010.03.008) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 2 A 27-year-old man known for asthma, presenting with fever, cough, shortness of breath, wheezing, myalgia, and diarrhoea. Isolated influenza A (H1N1) infection was confirmed by reverse-transcriptase polymerase chain reaction. (A) Postero-anterior (PA) chest radiograph at presentation, showing left lower lobe peribronchial thickening. (B) PA and lateral chest radiograph on day 2 with appearance of multiple, bilateral, small, round, and ill-defined consolidations, most of which are peripheral. (C) PA chest radiograph on day 3, showing progression of the multiple bilateral consolidations. Canadian Association of Radiologists Journal 2010 61, 233-240DOI: (10.1016/j.carj.2010.03.008) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 3 A 36-year-old, 34 weeks' pregnant woman, presenting with fever, cough, shortness of breath, arthralgia, and vomiting. Isolated influenza A (H1N1) infection was confirmed by reverse-transcriptase polymerase chain reaction. (A) Postero-anterior (PA) and lateral chest radiograph at presentation, showing a right middle lobe consolidation. (B) PA and lateral chest radiograph on day 3, showing progression of the right middle lobe consolidation and the appearance of multiple, bilateral, small, ill-defined air-space opacities (most visible in the middle third of the left lung and right upper lobe), most of which are peripheral. Canadian Association of Radiologists Journal 2010 61, 233-240DOI: (10.1016/j.carj.2010.03.008) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 4 A 32-year-old, postpartum woman, presenting with fever, cough, and myalgia. Influenza A (H1N1) infection was confirmed by reverse-transcriptase polymerase chain reaction. Superimposed Streptococcus pneumoniae pneumonia was also diagnosed, on the basis of sputum culture. Postero-anterior and lateral chest radiograph at presentation shows right middle lobe consolidation. Canadian Association of Radiologists Journal 2010 61, 233-240DOI: (10.1016/j.carj.2010.03.008) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions

Figure 5 A 68-year-old man known to have chronic obstructive pulmonary disease and chronic myeloid leukemia, presenting with fever and shortness of breath. Influenza A (H1N1) infection was confirmed by reverse-transcriptase polymerase chain reaction. Superimposed Klebsiella pneumoniae bronchopneumonia was also diagnosed, on the basis of endobronchial secretions culture. (A) Antero-posterior chest radiograph at presentation, showing diffuse peribronchial thickening, small, ill-defined (acinar) nodules in the lung bases, with small confluent areas in the right upper lobe and left lung base. (B) Computed tomography, showing tree-in-bud nodules in the lower lobes, and a small consolidation in the superior apical segment of the right lower lobe. Canadian Association of Radiologists Journal 2010 61, 233-240DOI: (10.1016/j.carj.2010.03.008) Copyright © 2010 Canadian Association of Radiologists Terms and Conditions