CTICasesWest Nile Virus Infection
Imaging findings
Chest CT in a patient with a history of West Nile virus infection presenting with acute flaccid paralysis shows severe, diffuse thinning and fatty atrophy of the diaphragmatic crura and the muscles of the chest wall and abdomen, with an indwelling tracheostomy tube in place.
Key takeaways
While West Nile virus typically causes a self-limited febrile illness, a small subset of patients develop neuroinvasive disease, including a poliomyelitis-like syndrome characterized by anterior horn cell destruction and acute flaccid paralysis. This can result in respiratory failure due to diaphragmatic paralysis, presenting on imaging as rapid, severe denervation muscle atrophy and fatty infiltration of the diaphragm and chest wall.
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