DOI: 10.1148/rg.271065074
Scrub Typhus: Clinical, Pathologic, and Imaging Findings1
Yeon Joo Jeong, MD,
Suk Kim, MD,
Yeh Dae Wook, MD,
Jun Woo Lee, MD,
Kun-Il Kim, MD and
Sun Hee Lee, MD
1 From the Department of Diagnostic Radiology (Y.J.J., S.K., Y.D.W., J.W.L., K.I.K.) and Division of Infectious Medicine, Department of Medicine (S.H.L.), Pusan National University Hospital, Pusan National University School of Medicine and Medical Research Institute, Pusan National University, 1-10 Ami-Dong, Seo-gu, Pusan 602-739, Republic of Korea. Presented as an education exhibit at the 2005 RSNA Annual Meeting. Received April 21, 2006; revision requested May 17 and received July 5; accepted July 10. All authors have no financial relationships to disclose.
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Figure 3a. Eschar from the bite of a Leptotrombidium mite. (a) Photograph shows an epidermal ulcer covered by a black crust surrounded by an erythematous halo. (b) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows dermal vasculitis with perivascular infiltrates that consist mostly of lymphocytes and macrophages.
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Figure 3b. Eschar from the bite of a Leptotrombidium mite. (a) Photograph shows an epidermal ulcer covered by a black crust surrounded by an erythematous halo. (b) High-power photomicrograph (original magnification, x400; hematoxylin-eosin stain) shows dermal vasculitis with perivascular infiltrates that consist mostly of lymphocytes and macrophages.
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Figure 4. Chest radiographic findings of scrub typhus. Initial radiograph in a 75-year-old woman shows septal lines, ground-glass opacity, peribronchial cuffing (arrows), redistribution of pulmonary vasculature, and an increased cardiothoracic ratio, as well as bilateral pleural effusion. Follow-up radiograph (not shown), obtained 4 days after treatment, revealed a decrease in the extent of parenchymal opacity.
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Figure 5. Chest radiographic findings of scrub typhus. Initial radiograph in a 66-year-old man shows multiple foci of reticular and patchy opacity in both lungs. Follow-up radiograph (not shown), obtained 5 months after treatment, showed resolution of the parenchymal lesions.
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Figure 6a. Scrub typhus in a 68-year-old man with previously diagnosed usual interstitial pneumonia. (a) Initial chest radiograph shows patchy opacity (arrow) in the upper lobe of the right lung and areas of reticular and ground-glass opacity near the base in both lungs, findings suggestive of usual interstitial pneumonia. (b) Axial thin-section (1.0-mm collimation) CT image obtained with lung window settings shows a focal area of ground-glass opacity in the upper lobe of the right lung. Follow-up thin-section CT images obtained 2 weeks later and 17 months later (not shown) revealed resolution of the parenchymal opacity in the right upper lobe.
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Figure 6b. Scrub typhus in a 68-year-old man with previously diagnosed usual interstitial pneumonia. (a) Initial chest radiograph shows patchy opacity (arrow) in the upper lobe of the right lung and areas of reticular and ground-glass opacity near the base in both lungs, findings suggestive of usual interstitial pneumonia. (b) Axial thin-section (1.0-mm collimation) CT image obtained with lung window settings shows a focal area of ground-glass opacity in the upper lobe of the right lung. Follow-up thin-section CT images obtained 2 weeks later and 17 months later (not shown) revealed resolution of the parenchymal opacity in the right upper lobe.
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Figure 8a. Scrub typhus in a 67-year-old woman. Axial thin-section (1.0-mm collimation) CT scans of the left (a) and right (b) lungs show centrilobular nodules (arrows in b) and interlobular septal thickening in the lower zone of both lungs.
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Figure 8b. Scrub typhus in a 67-year-old woman. Axial thin-section (1.0-mm collimation) CT scans of the left (a) and right (b) lungs show centrilobular nodules (arrows in b) and interlobular septal thickening in the lower zone of both lungs.
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Figure 9a. Scrub typhus in a 76-year-old woman. Axial contrast-enhanced CT images obtained with mediastinal window settings (a at a higher level than b) show enlarged bilateral hilar, mediastinal (arrows in a), and axillary (arrowheads in a) lymph nodes, as well as bilateral pleural effusion.
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Figure 9b. Scrub typhus in a 76-year-old woman. Axial contrast-enhanced CT images obtained with mediastinal window settings (a at a higher level than b) show enlarged bilateral hilar, mediastinal (arrows in a), and axillary (arrowheads in a) lymph nodes, as well as bilateral pleural effusion.
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Figure 10a. Acute respiratory distress syndrome in a 47-year-old woman with scrub typhus. (a) Initial anteroposterior chest radiograph shows diffuse ground-glass opacity in the right lung and the lower zone of the left lung and a small amount of pleural effusion in both lungs. (b) Follow-up anteroposterior chest radiograph obtained 6 days later shows extensive airspace consolidation in both lungs, a feature suggestive of acute respiratory distress syndrome.
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Figure 10b. Acute respiratory distress syndrome in a 47-year-old woman with scrub typhus. (a) Initial anteroposterior chest radiograph shows diffuse ground-glass opacity in the right lung and the lower zone of the left lung and a small amount of pleural effusion in both lungs. (b) Follow-up anteroposterior chest radiograph obtained 6 days later shows extensive airspace consolidation in both lungs, a feature suggestive of acute respiratory distress syndrome.
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Figure 11. Scrub typhus in a 47-year-old woman. Initial anteroposterior chest radiograph shows an increased cardiothoracic ratio. Follow-up chest radiography, performed 15 days after treatment, demonstrated a decrease in the size of the heart.
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Figure 12a. Scrub typhus in a 58-year-old man with abdominal pain and fever. Serial contrast-enhanced abdominal CT images depict periportal areas of low attenuation (arrows in a) in the liver, pericholecystic edema, and enlarged lymph nodes in the portocaval and para-aortic regions (arrowheads in b).
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Figure 12b. Scrub typhus in a 58-year-old man with abdominal pain and fever. Serial contrast-enhanced abdominal CT images depict periportal areas of low attenuation (arrows in a) in the liver, pericholecystic edema, and enlarged lymph nodes in the portocaval and para-aortic regions (arrowheads in b).
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Figure 13a. Scrub typhus in a 50-year-old man. Arterial phase dynamic CT images (a at a higher level than b) show mild inhomogeneous enhancement of the hepatic parenchyma as well as splenomegaly.
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Figure 13b. Scrub typhus in a 50-year-old man. Arterial phase dynamic CT images (a at a higher level than b) show mild inhomogeneous enhancement of the hepatic parenchyma as well as splenomegaly.
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Figure 14a. Scrub typhus in a 52-year-old man. (a) Longitudinal US image shows gallbladder wall thickening and gallbladder distention. (b) Transverse US image, obtained at follow-up 2 weeks after appropriate treatment, shows decreased gallbladder wall thickening.
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Figure 14b. Scrub typhus in a 52-year-old man. (a) Longitudinal US image shows gallbladder wall thickening and gallbladder distention. (b) Transverse US image, obtained at follow-up 2 weeks after appropriate treatment, shows decreased gallbladder wall thickening.
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Figure 15a. Scrub typhus in a 68-year-old man. (a) Initial contrast-enhanced abdominal CT image depicts splenomegaly. (b) Follow-up contrast-enhanced abdominal CT image demonstrates a decrease in the size of the spleen.
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Figure 15b. Scrub typhus in a 68-year-old man. (a) Initial contrast-enhanced abdominal CT image depicts splenomegaly. (b) Follow-up contrast-enhanced abdominal CT image demonstrates a decrease in the size of the spleen.
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Figure 16a. Scrub typhus in a 78-year-old woman. (a) Contrast-enhanced abdominal CT image demonstrates a wedge-shaped hypoattenuated lesion (arrow) in the spleen, a finding indicative of a splenic infarct. Periportal areas of low attenuation (arrowheads) also are visible throughout the hepatic parenchyma. (b) Contrast-enhanced abdominal CT image, obtained at a level 2 cm inferior to a, depicts gallbladder wall thickening (arrowhead), a tiny gallstone, and enlarged lymph nodes (arrows) in the aortocaval and para-aortic regions.
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Figure 16b. Scrub typhus in a 78-year-old woman. (a) Contrast-enhanced abdominal CT image demonstrates a wedge-shaped hypoattenuated lesion (arrow) in the spleen, a finding indicative of a splenic infarct. Periportal areas of low attenuation (arrowheads) also are visible throughout the hepatic parenchyma. (b) Contrast-enhanced abdominal CT image, obtained at a level 2 cm inferior to a, depicts gallbladder wall thickening (arrowhead), a tiny gallstone, and enlarged lymph nodes (arrows) in the aortocaval and para-aortic regions.
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Figure 17a. Scrub typhus in a 73-year-old man. (a, b) Serial contrast-enhanced abdominal CT images (a obtained at a higher level than b) demonstrate mild splenomegaly, bilateral pleural effusion, gallbladder wall thickening, and a small amount of ascites (arrow in b). (c) Fiberoptic gastroscopic image shows superficial mucosal hemorrhages and multiple ulcers.
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Figure 17b. Scrub typhus in a 73-year-old man. (a, b) Serial contrast-enhanced abdominal CT images (a obtained at a higher level than b) demonstrate mild splenomegaly, bilateral pleural effusion, gallbladder wall thickening, and a small amount of ascites (arrow in b). (c) Fiberoptic gastroscopic image shows superficial mucosal hemorrhages and multiple ulcers.
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Figure 17c. Scrub typhus in a 73-year-old man. (a, b) Serial contrast-enhanced abdominal CT images (a obtained at a higher level than b) demonstrate mild splenomegaly, bilateral pleural effusion, gallbladder wall thickening, and a small amount of ascites (arrow in b). (c) Fiberoptic gastroscopic image shows superficial mucosal hemorrhages and multiple ulcers.
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Copyright © 2007 by the Radiological Society of North America.
