Inhalational Anthrax: Radiologic and Pathologic Findings in Two Cases

The occurrence of 11 cases of inhalational anthrax associated with letters containing Bacillus anthracis powder sent through the United States Postal Service in Florida, New York, New Jersey, and in Washington, DC, in September and October 2001 has emphasized the necessity for health care practitioners to be familiar with the manifestations of inhalational anthrax. A wide variety of health care practitioners, including radiologists and pathologists, have the potential to alert other physicians to the possibility of inhalational anthrax because the clinical manifestations of early disease are nonspecific, consisting of flulike symptoms, fever, sweats, malaise, and myalgias. In the absence of known exposure to B. anthracis, the appropriate cultures may not be obtained, and potentially life-saving therapy may not be instituted in a timely manner. The predicted case fatality of inhalational anthrax from historical data was approximately 90% [1]. The United States outbreak showed that with early diagnosis and institution of antimicrobial therapy, mortality can be substantially reduced [2]. In addition, timely identification of inhalational anthrax cases is important so that appropriate public health and law enforcement officials can be notified and can take necessary measures to limit morbidity and mortality. Such notification allows other patients and clinicians to be alerted about the potential for new exposure and allows evidence about the perpetrator to be collected expeditiously. The clinical histories of the 11 cases of bioterrorism-related inhalational anthrax in the United States have been described in detail in several recent publications [2–7]. Here we describe the clinical course of two of the affected patients, with emphasis on imaging findings, in an effort to increase clinician awareness about this disease. We also provide correlation with the postmortem examination of the fatal case.