Introduction

Chest radiography (CXR) not only plays an important role in the diagnosis of severe acute respiratory syndrome (SARS), it is crucial in the management of these patients. During treatment there are variable clinical and radiological responses in different patients and serial CXR help in deciding whether escalation to more aggressive treatment is necessary.

Based on our preliminary experience, we believe that changes on serial radiographs is also an important prognostic indicator.

This chapter aims to examine the correlation between the clinical course and the radiological features, and the role of CXR in the management of SARS.

Treatment protocol

The treatment of SARS patients is discussed in detail in a separate chapter (see Chapter 9). However, in order to better understand the clinical and radiological correlation one must be familiar with the basic treatment principles. These are therefore discussed briefly in the following paragraph.

Patients were treated for the first 2 days with broad-spectrum antibiotics for community-acquired pneumonia according to the American Thoracic Society Guidelines. Our initial treatment consisted of intravenous (IV) cefotaxime 1 g every 6 hours and oral clarithromycin 500 mg twice daily (or oral levofloxacin 500 mg daily for those who could not tolerate clarithromycin).

Clinical symptoms, arterial blood oxygen saturation and CXR were assessed daily.