Anthrax chest x ray

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Chest X Ray

Inhalational Anthrax

  • The earliest detectable specific finding indicative of inhalational anthrax is mediastinal widening on posteroanterior chest X-rays. However, mediastinal widening is not a rare finding in a series of patients presenting at a emergency department.
  • Lymphatic stasis resulting from the damaged lymph nodes leads to dilatation of pulmonary lymphatics which originate in the pleura and drain towards the hilum, following interlobular septa in association with blood vessels. The lymphatic stasis manifests as an early onset pleural effusion and peripheral infiltrates, representing thickened bronchovascular bundles, detectable on chest X-ray. These findings mark fully developed initial stage illness.
  • Ultimately, the bacteria escape from the damaged lymph nodes and invade the blood stream via the thoracic duct. Once the bacteremia and associated toxemia reach a critical level, the severe symptoms characteristic of the acute phase illness are manifest. During the acute phase illness, damage of the lung tissue becomes apparent on X-ray. This damage results from the action of anthrax toxin on the endothelium of the lung’s capillary bed. Primary damage of the lung is not normally a feature of the initial phase illness and primary pulmonary infection is an uncommon presentation.

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References

  1. Turnbull, Peter (2008). Anthrax in humans and animals. Geneva, Switzerland: World Health Organization. ISBN 9789241547536.
  2. 2.0 2.1 2.2 2.3 2.4 "Public Health Image Library (PHIL), Centers for Disease Control and Prevention".