Multimodality Imaging Findings in Waterhouse-Friderichsen Syndrome: A Case Report and a Short Literature Review
, Claudia Dell’Atti 1, Federico Orsini 1, Andrea Piccioni 2, Laura Franza 2, Martina Petrucci 2, Tommaso Pirronti 1,3, Francesco Franceschi 2,3 and Marcello Covino 2,3Round 1
Reviewer 1 Report
Authors present a case report of Waterhouse-Friderichsen syndrome. There are several reports of this syndrome in the literature, however the manuscript is well-written and interesting.
Consider mentioning that image in fig 3c is T1 post-contrast with fat suppression. You could also consider showing a T1WI with fat suppression before gadolinium administration (instead of 3a), in order to highlight the T1 hyperintensities and compare with the post-contrast image.
Given that this paper may be of educational value for residents of different medical specialties, I would suggest adding arrows in the figures.
In the discussion section consider adding a short phrase with the other common infections that may be complicated with Waterhouse-Friderichsen syndrome.
Author Response
Point 1. Consider mentioning that image in fig 3c is T1 post-contrast with fat suppression. You could also consider showing a T1WI with fat suppression before gadolinium administration (instead of 3a), in order to highlight the T1 hyperintensities and compare with the post-contrast image.
Response 1. We did not include a T1WI with fat suppression before gadolinium administration because it was very deteriorated by motion artifacts, but we
Reviewer 2 Report
As the authors mentioned, Waterhouse_Friderichsen syndrome is a rare disease with high morbidity and mortality. This article is very useful to educate the awareness the disease for early diagnosis and appropriate treatment. However, the following questions need to be improved:
（1）The Key Words part should include the Imaging or Multimodality imaging, because the report focuses the multimodality imaging findings.
(2) Please check the minor spell or edit errors, for example 1.5T MRI, 1.25mm slice width, et al.
(3) Please add the CT density values(before and after contrast), because it's very important for the diagnosis.
(4)Color-coded ultrasound is very useful for the diagnosis, which is more important that B ultrasound. Please add the color Doppler ultrasound imaging if possible, and discuss it with details.
(5)According to the imaging findings, there can be some other differential diagnosis to be mentioned and illustrated, which is very useful for the radiological diagnosis.
Author Response
Point 1. The Key Words part should include the Imaging or Multimodality imaging, because the report focuses the multimodality imaging findings.
Response 1. We agree with the comment and will submit the modification required.
Point 2. Please check the minor spell or edit errors, for example 1.5T MRI, 1.25mm slice width, et al.
Response 2. We agree with the comment and will submit the modification required.
Point 3. Please add the CT density values(before and after contrast), because it's very important for the diagnosis.
Response 3. We agree with the comment and will submit the modification required.
Point 4. Color-coded ultrasound is very useful for the diagnosis, which is more important that B ultrasound. Please add the color Doppler ultrasound imaging if possible, and discuss it with details.
Response 4. Unfortunately no Color-coded ultrasound imaging were saved during the ultrasound scan in the emergency department.
Point 5. According to the imaging findings, there can be some other differential diagnosis to be mentioned and illustrated, which is very useful for the radiological diagnosis.
Response 5. We agree with the comment and will submit the modification required.
