2016 Reply to _Chest Radiographs of the Acute Middle East Respiratory Syndrome Coronavirus_

1 Pages·2016·0.41 MB·English

AJR:206, January 2016
W39

Letters

AJR 2016; 206:W39 0361–803X/16/2061–W39 © American Roentgen Ray Society

Reply to “Chest Radiographs of
the Acute Middle East
Respiratory Syndrome Coronavirus”
We appreciate the comments from Joob and
Wiwanitkit [1]. We share their concern about
the challenge that practitioners may encounter
when evaluating an asymptomatic or mild case
of Middle East respiratory syndrome corona-
virus (MERS-CoV). Although no appreciable
abnormality was detected on initial chest ra-
diographs in 17% of the patients infected with
MERS-CoV in our study, the remaining 83%
presented with lung parenchymal abnormali-
ties [2, 3]. On chest radiography, MERS-CoV
was characterized by ground-glass opacity
(66%), and lung parenchymal abnormalities
had a peripheral mid and lower lung zone pre-
dominance [2]. However, we believe that CT,
which is more sensitive and specific than chest
radiography, should be considered for confir-
mation, characterization, and assessment of
disease progress in patients who are likely or
known to be infected with MERS-CoV but
who have mild or no symptoms and normal or
equivocal chest radiographic findings [3].
The radiologic features of peripheral air-
space opacification in the majority of our
cohort were one of several striking similari-
ties to severe acute respiratory syndrome [4].

Peripheral airspace opacities are also noted
with other causes of atypical pneumonia,
such as Chlamydia, Mycoplasma, Legionel-
la, other types of viral pneumonia in adults,
and H1N1 influenza [5–7]. We believe that
MERS-CoV infection should be suspected
when ground-glass opacities with peripheral
lower lobe preference are seen on imaging
studies in patients with or without symptoms
but with risk factors as well as suspicious
clinical findings and laboratory results. As
Joob and Wiwanitkit [1] correctly pointed
out, asymptomatic or mild MERS-CoV in-
fection may present with a different pattern
of imaging findings, and future study is nec-
essary to further elucidate potentially char-
acteristic imaging findings of MERS-CoV.
Karuna M. Das
College of Medicine and Health Science
Al Ain, United Arab Emirates
Sven G. Larsson
King Fahad Medical City
Riyadh, Saudi Arabia
Edward Y. Lee
Boston Children’s Hospital and Harvard
Medical School
Boston, MA

DOI:10.2214/AJR.15.15361
WEB—This is a web exclusive article.

References
1. Joob B, Wiwanitkit V. Chest radiographs of the
acute Middle East respiratory syndrome. AJR
2016; 206:w38
2. Das KM, Lee EY, Jawder SE, et al. Acute Middle
East respiratory syndrome coronavirus: temporal
lung changes observed on the chest radiographs of
55 patients. AJR 2015; 205:W267–W274
3. Das KM, Lee EY, Enani MA, et al. CT correlation
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