Inhalational Anthrax after Bioterrorism Exposure: Spectrum of Imaging Findings in Two Surviving Patients

Abstract

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.

Inhalational anthrax in a vaccinated soldier

“…Although historically felt to be universally fatal, survival from inhalational anthrax has improved, especially since the advent of intensive care unit care [6]. Two survivors of bioterrorism-related inhalational anthrax reportedly demonstrated similar features and progress to our patient, including the typical features of mediastinal widening by marked lymphadenopathy (with nodes of increased attenuation due to acute haemorrhage), pleural effusions and air space consolidation [7].…”

Fluid support worsens outcome and negates the benefit of protective antigen-directed monoclonal antibody in a lethal toxin-infused rat Bacillus anthracis shock model*

“…In contrast, patients requiring similar support for septic shock due to other bacteria types have mortality rates of 40% to 60% (6). Furthermore, pleural fluid accumulation requiring repeated thoracentesis and hemoconcentration as reflected by increased hemoglobin concentration was common in patients with B. anthracis but is not in other types of bacterial sepsis (4,7). These differences support the observation that the pathogenesis and physiology of shock with B.…”

Bacillus anthracis lethal toxin induces TNF-α–independent hypoxia-mediated toxicity in mice

“…Pulmonary edema has also been associated with many models of LT-mediated lethality, including the uniquely rapid death of Fischer 344 rats (8). Humans and primates infected by aerosol exposure to spores present pleural effusions as the most common symptom of disease (9)(10)(11)(12)(13)(14).…”