Hantavirus Impact in Emergency Radiology: Insights on Imaging and Control Measures

In April 2026, several severe respiratory illness cases were reported aboard the MV Hondius, a cruise ship originating from Argentina. Laboratory results identified the Andes virus (ANDV), a subtype of hantavirus that, although rare, can spread between humans. Hantavirus infections, characterized by hantavirus pulmonary syndrome (HPS) and hemorrhagic fever with renal syndrome (HFRS), present significant challenges due to rapid disease progression and high mortality rates, necessitating prompt and accurate radiological diagnosis in emergency settings.

Hantaviruses belong to the negative-sense, single-stranded RNA virus family and typically transmit to humans via aerosolized rodent excreta. The Andes virus, however, is notable for its documented human-to-human transmission in certain cases. The April 2026 outbreak on MV Hondius underscores the importance of early recognition and history-taking in emergency departments, especially when considering infection-control protocols.

Radiologists play a crucial role in identifying early signs of hantavirus infection, such as diffuse non-cardiogenic pulmonary edema and bilateral ground-glass opacities, often in the presence of normal heart size. These imaging features necessitate rapid detection to facilitate correct diagnosis and treatment interventions, including potential extracorporeal membrane oxygenation (ECMO) and timely triage in emergency settings.

HPS presents primarily with pulmonary involvement, such as increased capillary permeability leading to fluid buildup in lung pathways, resulting in interstitial opacities and possible alveolar consolidation. Another hallmark of the disease is the pleural effusion appearance. The renal manifestations associated with HFRS often include kidney enlargement and retroperitoneal edema, detected via imaging, which can inform on the disease phase progression.

Hantavirus infections require strict infection-control practices, particularly for ANDV due to its transmission potential. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend standard precautions for most hantaviruses and escalate to droplet and contact precautions for suspected ANDV cases. Radiology departments must adopt measures like minimizing patient transport, using dedicated routes, and decontaminating radiology equipment to prevent potential cross-infection.

The role of imaging is reinforced by the necessity to rapidly assess disease progression in high-volume settings. Employing portable imaging when possible and interpreting results in conjunction with clinical indicators is vital for accurate diagnosis. HRCT imaging is specifically instrumental in distinguishing early interstitial changes and diagnosing HPS, while CT scans are reserved for equivocal cases or complications.

Overall, hantavirus outbreaks present multifaceted challenges for radiology and critical care teams, emphasizing the need for timely diagnosis, stringent infection-control measures, and a comprehensive understanding of the imaging characteristics and systemic influences of the virus. Integrating these practices strengthens preparedness and enhances response strategies in emergency radiology departments.