November 29, 2001 CHICAGO (AP) - Although CT scans can help quickly diagnose cases of inhaled anthrax, the flu season poses new challenges for doctors who must decide whether patients need to receive the advanced imaging, experts said.
"It's going to come down to clinical acumen," said Dr. Jeffrey R. Galvin, head of the radiologic pathology department at the Armed Forces Institute of Pathology. "Unfortunately, we don't know when to take the step to use CT because the initial phase of anthrax looks like a viral infection, but anthrax is caused by a bacteria."
Galvin and two doctors who treated anthrax patients in Virginia and New York were at the Radiological Society of North America's annual meeting to discuss diagnosis of the deadly disease.
CT scans show more definitive signs of anthrax - enlarged lymph nodes filled with blood and fluid and blood around the heart and lungs - unlike chest x-rays, which reveal fluid around the lungs, symptoms also consistent with pneumonia and other illnesses.
Complicating matters is that some inhalation anthrax patients "don't appear horribly sick," said Dr. James P. Earls, a radiologist from Inova Fairfax Hospital in Falls Church, Va., where two postal workers were successfully treated for inhalation anthrax.
"Early recognition is important, but as we approach flu season, this could be difficult," Galvin said.
The case of Kathy T. Nguyen, a 61-year-old New York hospital worker who died of inhalation anthrax, still baffles investigators.
Doctors first began treating Nguyen for congestive heart failure after an X-ray showed a widened chest cavity and fluid around her lungs, said Dr. Christopher M. Krol, a radiology resident at Lenox Hill Hospital in New York.
A CT scan performed hours later showed enlarged lymph nodes with fluid and blood, leading to the anthrax diagnosis, Krol said. Nguyen died 67 hours after entering the hospital.
Galvin said the Armed Forces Institute of Pathology has established a Web site with images of all the inhalation anthrax cases for doctors who want to compare them with their CT scans.
Copyright 2001 The Associated Press. All rights reserved.
