The incidence of severe pneumonia does not differ among human rhinovirus A (18.6%), human rhinovirus B (21.4%), and human rhinovirus C (20.0%), and in-hospital mortality rates also do not differ significantly (81). Schemas show typical CT patterns of viral pneumonia. These findings support using the same management principles for patients with CT-only pneumonia and those with pneumonia seen on chest radiography. (a) Initial chest radiograph shows increased areas of ill-defined nodular opacity (arrows) in both lower lung zones, especially in the left retrocardiac area. (b, c) Thin-section (1-mm collimation) axial CT image (b) and coronal reconstructed CT image (5-mm thickness) (c) obtained on the same day show multifocal ill-defined small areas of nodular opacity (arrows) with the GGO halo sign in both lungs. In the CT scans of his lungs, white patches can clearly be seen. The animal hosts of SARS coronavirus appear to include the masked palm civet, raccoon dogs, and the Chinese ferret-badger (73). CT patterns of viral pneumonia are related to the pathogenesis of viral infections. (a) Initial chest radiograph shows extensive patchy consolidation (arrows) with air bronchogram (arrowheads) in both lungs, especially in the middle to lower lung zones. Hantavirus is another genus of Bunyaviridae; its member viruses exist in the environment because of persistent infection of their hosts, typically rodents, insectivores, and bats. Antiviral therapy can reduce attack rates and decrease outbreaks and could reduce the public health burden. Recently, new viruses associated with recent outbreaks including human metapneumovirus, severe acute respiratory syndrome coronavirus, and Middle East respiratory syndrome coronavirus have been discovered. Histologically, the nodules consist of an outer lamellated fibrous capsule enclosing hyalinized collagen or necrotic tissue. Intrathoracic involvement of infectious mononucleosis is very uncommon. Pneumonia due to influenza A virus in a 38-year-old pregnant woman at the gestational age of 29 weeks and 5 days who presented with a cough and dyspnea. Pneumonia due to HMPV in a 50-year-old woman who presented with fever, cough, and sputum. Figure 1d. Reticular opacity also can be present. In most immunocompetent patients, adenovirus pneumonia is mild, is associated with upper respiratory symptoms, and resolves within 2 weeks. The patient underwent reverse-transcription polymerase chain reaction for viral infection with sputum and blood culture and bronchoalveolar lavage to find superimposed infection. (b, c) Axial thin-section (1-mm collimation) CT images at the carina (b) and the left inferior pulmonary vein level (c) show diffuse interstitial and interlobular septal thickening (arrowheads) with patchy GGO (arrows) in both lungs. 2015 Oct 15;192(8):974-82. doi: 10.1164/rccm.201501-0017OC. Here are some before and after images of my Lymphoma. More than 40 hantavirus species are known, and greater than 20 of these are considered pathogenic in humans. Obstructing lesions in the bronchi can be found which would ordinarily be missed by X-ray as can enlarged lymph nodes. Acad Emerg Med. Radiographic consolidation of the alveoli begins in the peripheral airspaces, as in the image below. Self WH, Upchurch CP, Wunderink RG, Waterer GW, Grijalva CG, Edwards KM. COVID-19 is an emerging, rapidly evolving situation. (b, c) Axial chest CT images obtained on the same day at the lower trachea level (b) and the interlobar area level (c) show multiple irregular areas of nodular tree-in-bud opacity and patchy consolidations (arrows) along the bronchovascular bundles and mild bronchial wall thickening. These findings also disappear with healing of the skin lesions after antiviral therapy (24). How does a coronavirus infection progress to pneumonia in the lungs? In people with serious COVID-19 symptoms, doctors may use CT scans to look for signs of pneumonia. The early stages of disease often demonstrate tracheobronchitis and neutrophilic bronchopneumonia. March 6, 2020 — While COVID-19, previously known as the novel coronavirus, was first reported in China, it was recently declared a global health emergency by the World Health Organization. Although a definite diagnosis cannot be achieved on the basis of imaging features alone, recognition of viral pneumonia patterns may aid in differentiating viral pathogens, thus reducing the use of antibiotics. -, Kocher K.E., Meurer W.J., Fazel R., Scott P.A., Krumholz H.M., Nallamothu B.K. The most common radiologic abnormalities are mediastinal lymphadenopathy, and, rarely, interstitial infiltrates and widespread GGO can be seen. Background: Pneumonia due to CMV in a 28-year-old man with graft-versus-host disease after bone marrow transplantation for chronic myeloblastic leukemia. 4, 5 June 2020 | RadioGraphics, Vol. There are few features that can help distinguish on CT scan. (a, b) Initial axial chest CT images at the main bronchial level (a) and the interlobar area level (b) show multifocal ill-defined nodular GGO lesions (arrows) along the bronchovascular bundles and mild bronchial wall thickening (arrowheads). *The main routes of transmission are listed first. (b, c) Axial chest CT images (5-mm thickness) obtained on the same day at the interlobar bronchi level (b) and the inferior pulmonary vein level (c) show ill-defined patchy GGO (arrowheads) and lobar consolidations (arrows). Centrilobular nodules, pseudocavitation, pneumatocele formation, and lymphadenopathy also are seen often (68). Figure 13b. Herpes simplex virus (HSV) has cytopathic effects in both the airways and alveoli; these manifest as a multifocal scattered airspace pattern of opacity and predominant areas of peribronchial consolidation. Epstein-Barr virus infects B lymphocytes and pharyngeal epithelial cells. Also, complications like early abscess formation and fluid accumulation around the lungs is easier to detect. Pneumonia … Initial chest radiographs are normal but soon progress to show multifocal airspace consolidation, predominantly in the lower lung zone. For solid-organ transplantation, recipients of lung and small intestine transplants are at highest risk, and this may be associated with the intensity of immunosuppression and the amount of lymphoid tissue in transplanted organs. The virus is commonly detected in nasopharyngeal aspirates of children who are suspected to have respiratory tract infections, and multiple viral coinfections are common (34). Figure 12a. The lesions may calcify, and well-defined scattered 2–3-mm hyperattenuating calcifications can persist (25). CMV is a common human pathogen that usually causes an asymptomatic infection or mild flu-like symptoms in immunocompetent patients. Clinical symptoms include fever, gastrointestinal problems, myalgia, thrombocytopenia, and increased liver enzyme levels. HSV type 1 pneumonia is uncommon, usually localized, and well tolerated in healthy individuals; however, it is observed in immunocompromised patients or individuals whose airways have been traumatized by intubation, smoke inhalation, or chronic cigarette smoking (18). Large cell cancer (another NSCLC) is responsible for about 10% of all cases. However, there was no evidence of coinfection. Biopsy is one of the way to figure out the cause of findings on CT scan. Pneumonia due to HSV in a 72-year-old woman with multiple myeloma. It is sometimes classified as atypical pneumonia. (a) Initial chest radiograph shows multiple irregular nodular peribronchial air spaces or GGO (arrows) in both lungs and a small amount of bilateral pleural effusion. The viruses usually appear as multifocal patchy consolidation with GGO, and centrilobular nodules with bronchial wall thickening are also noticed. (b, c) Axial chest CT images (5-mm thickness) obtained on the same day at the interlobar bronchi level (b) and the inferior pulmonary vein level (c) show ill-defined patchy GGO (arrowheads) and lobar consolidations (arrows). Figure 6b. The airway walls are congested, and mononuclear cell infiltrates and degeneration of epithelial cells are noted. 2004 Sep 1;117(5):305-11. doi: 10.1016/j.amjmed.2004.03.029. Basi SK, Marrie TJ, Huang JQ, Majumdar SR. Am J Med. However, in individuals with chronic diseases, the elderly, and infants, severe complications from influenza A viruses, including hemorrhagic bronchitis or fulminant pneumonia (primary viral or secondary bacterial), may occur. Schemas show typical CT patterns of viral pneumonia. In medical school radiology they said, “ The lung is stupid. The radiologic features of SARS are similar to those of other community-acquired types of pneumonia. The CT picks them up as tissue that is different than the surrounding area which is why they light-up white on the images and are easier to see. 7, 23 July 2020 | Radiology: Cardiothoracic Imaging, Vol. (a) Initial chest radiograph shows ill-defined patchy consolidation and GGO (arrows) in the left middle to lower lungs and the right lower lung zone. (c, d) Follow-up axial chest CT images obtained 10 days later show an increased extent and intensity of lesions and increased irregular consolidation (arrows) along the bronchovascular bundles. Infectious mononucleosis caused by Epstein-Barr virus infection usually occurs in adolescents with a triad of symptoms including fever with insidious onset of weakness (malaise), tonsillar pharyngitis, and lymphadenopathy. (a) Initial chest radiograph shows multiple irregular nodular peribronchial air spaces or GGO (arrows) in both lungs and a small amount of bilateral pleural effusion. Figure 9b. (b) Chest radiograph obtained 3 weeks later shows decreased intensity of irregular consolidation (arrows). ), Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, South Korea; and Department of Radiology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, South Korea (S.L. Thickened interlobular septa also are observed. 70%]. Ribavirin is multipotent for the treatment of RSV, adenovirus, HPIV, and HMPV. Clinical characteristics that could affect imaging, such as patient age and immune status, seasonal variation and community outbreaks, and pathogenesis, are also discussed. Table 3: Taxonomy of Viral Pneumonia Pathogens, Diagnostic Tests, and Treatment. An adenovirus infection occurs in 10.5% of patients undergoing hematopoietic stem cell transplantation; younger age, alternative donor grafts, and acute graft-versus-host disease are risk factors for infection (15). Herpesviridae have the ability to remain latent in tissue after the acute infection has resolved and can be reactivated by internal and external triggers. (b) Chest radiograph obtained 3 weeks later shows decreased intensity of irregular consolidation (arrows). Figure 11b. Recent research found that the sensitivity of CT for COVID-19 infection was 98 percent compared to RT-PCR testing sensitivity of 71 percent. Some reports from China have suggested that, in some patients with COVID-19 pneumonia, abnormalities on chest CT may appear despite negative swab tests. In the study, children younger than 5 years were more prone to infection than were older children (37% vs 8%, respectively). It is spread by means of direct person-to-person contact between susceptible individuals and those who are asymptomatic Epstein-Barr virus shedders. Pneumonia due to human bocavirus in a 63-year-old man who presented with fever and had undergone chemotherapy for primary central nervous system lymphoma. Figure 7d. A diffuse airspace pattern was seen more frequently in patients with bacterial infections. The manifestations of HPIV infection are diverse, including otitis media, conjunctivitis, pharyngitis, croup, bronchitis, and pneumonia. †In immunocompromised patients, the reduction of immunosuppressive drugs generally is recommended. Pneumonia due to RSV in a 58-year-old woman with acute myeloid leukemia who presented with fever. With the recent advancement in molecular biology and the ability to amplify multiple viral genomes by using multiplex reverse-transcription polymerase chain reaction assays, several new human respiratory viruses, such as human metapneumovirus (HMPV), human coronaviruses, and bocavirus have been discovered (3,4). (c) Axial CT image obtained on the same day as b shows irregular consolidation (arrows) along the bronchovascular bundles and diffuse GGO with interlobular septal thickening (arrowheads) in both lungs. This was usually done with a CT scan or chest x-ray. ). The role of Epstein-Barr virus as an infective pathogen in the development of lung disease is controversial. Schemas show typical CT patterns of viral pneumonia. Clinically diagnosed infections have been described in both immunocompetent and immunocompromised patients. With recovery from the initial disease, spherical nodules are observed scattered randomly throughout the lung parenchyma. Can be similar: On non contrast CT scan it is difficult to differentiate in some cases atelectasis from pneumonia. There are various types of lymphoproliferative disorders associated with Epstein-Barr virus infection, such as lymphomatoid granulomatosis, lymphoma, and posttransplantation lymphoproliferative disorder (31). Viewer, Review of the Chest CT Differential Diagnosis of Ground-Glass Opacities in the COVID Era, Chest CT in COVID-19: What the Radiologist Needs to Know, Diagnostic Accuracy of North America Expert Consensus Statement on Reporting CT Findings in Patients Suspected of Having COVID-19 Infection: An Italian Single-Center Experience, RadioGraphics Update: Radiographic and CT Features of Viral Pneumonia, Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19), COVID-19: A Multimodality Review of Radiologic Techniques, Clinical Utility, and Imaging Features, CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV), Emerging 2019 Novel Coronavirus (2019-nCoV) Pneumonia, Thin-Section Chest CT Imaging of COVID-19 Pneumonia: A Comparison Between Patients with Mild and Severe Disease, Chest CT Findings in Cases from the Cruise Ship Diamond Princess with Coronavirus Disease (COVID-19), Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19, Acute Pulmonary Complications in Patients with Hematologic Malignancies, High-resolution CT Findings of Viral Pneumonias: What Radiologists Should Know, Diffuse Ground-glass Attenuation on CT; Key Points to Make a Differential Diagnosis, The Wide Spectrum of Viral Pneumonias in Adults. There are many causes for cloudiness on both lungs on CT THORAX. SARS mortality in 2003 was estimated at 6.8%–13.2% for patients younger than 60 years and 43%–50% for patients older than 60 years. In patients with severe rhinovirus pneumonia, bilateral patchy consolidation with multifocal GGO and interlobular septal thickening are noted (83) (Fig 13). Pulmonary infections correlate with a fall in CD4 lymphocytes. Figure 9a. (a) Initial chest radiograph shows diffuse ill-defined GGO (arrows) in both lungs. Conclusion Bedside lung ultrasound is a reliable and accurate tool that appears to be superior to CXR for diagnosing pneumonia … (b, c) Thin-section (1-mm collimation) axial (b) and coronal (c) reconstructed (5-mm section thickness) chest CT images obtained on the same day show multiple ill-defined centrilobular nodules (arrows) or GGO (arrowheads) along the bronchovascular bundles and mild bronchial wall thickening in both lungs, especially in the right lung. 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