The use of anthrax as a weapon of biological terrorism has moved from theory to reality in recent weeks. Following processing of a letter containing anthrax spores that had been mailed to a US senator, 5 cases of inhalational anthrax have occurred among postal workers employed at a major postal facility in Washington, DC. This report details the clinical presentation, diagnostic workup, and initial therapy of 2 of these patients. The clinical course is in some ways different from what has been described as the classic pattern for inhalational anthrax. One patient developed low-grade fever, chills, cough, and malaise 3 days prior to admission, and then progressive dyspnea and cough productive of blood-tinged sputum on the day of admission. The other patient developed progressively worsening headache of 3 days' duration, along with nausea, chills, and night sweats, but no respiratory symptoms, on the day of admission. Both patients had abnormal findings on chest radiographs. Non-contrast-enhanced computed tomography of the chest showing mediastinal adenopathy led to a presumptive diagnosis of inhalational anthrax in both cases. The diagnoses were confirmed by blood cultures and polymerase chain reaction testing. Treatment with antibiotics, including intravenous ciprofloxacin, rifampin, and clindamycin, and supportive therapy appears to have slowed the progression of inhalational anthrax and has resulted to date in survival.

Knowledge of sites of ongoing hemorrhage is crucial for optimizing the sequence of diagnostic and therapeutic studies in patients with blunt trauma. Contrast-enhanced CT of the pelvis, which is often performed for hemodynamically stable trauma patients, is a noninvasive technique that is highly accurate in determining the presence or absence of ongoing pelvic hemorrhage. This information can assist in initial management decisions involving patients with multisystem trauma and major pelvic fractures.

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The radiographic and computed tomographic (CT) findings in two patients with documented inhalational anthrax resulting from bioterrorism exposure are presented. Chest radiographs demonstrated mediastinal widening, adenopathy, pleural effusions, and air-space disease. Chest CT images revealed enlarged hyperattenuating mediastinal and hilar lymph nodes and edema of mediastinal fat. Chest CT findings are helpful for making the initial diagnosis. To the authors' knowledge, the spectrum and follow-up of CT findings have not been previously described.