Imaging and clinical manifestations of viral pneumonia are protean and not reliably predictive of its origin. All patients with neutropenic fever and normal findings at chest radiography should undergo thin-section computed tomography to determine whether parenchyma abnormalities are present. Although the radiologic manifestations of viral pneumonia are nonspecific and difficult to differentiate from those of other infections, it is important to consider viral infection when confronted with a rapidly progressive pneumonia in patients with risk factors for infection. Although definitive diagnosis cannot be made on the basis of imaging features alone, the use of a combination of clinical and radiographic findings can substantially improve the accuracy of diagnosis in this disease.

TBLB by cryoprobe is safe and potentially useful in the diagnosis of ILD. Larger multisite randomized trials are required to confirm the potential benefits of this procedure. Clinical trial registration at ClinicalTrials.gov: NCT01064609.

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Identification of honeycombing at CT is subjective, and disagreement is largely caused by conditions that mimic honeycombing.

The "crazy-paving" pattern is a common finding at thin-section computed tomography (CT) of the lungs. It consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines. This finding has a variety of causes, including infectious, neoplastic, idiopathic, inhalational, and sanguineous disorders. Specific disorders that can cause the crazy-paving pattern include Pneumocystis carinii pneumonia, mucinous bronchioloalveolar carcinoma, pulmonary alveolar proteinosis, sarcoidosis, nonspecific interstitial pneumonia, organizing pneumonia, exogenous lipoid pneumonia, adult respiratory distress syndrome, and pulmonary hemorrhage syndromes. Knowledge of the many causes of this pattern can be useful in preventing diagnostic errors. In addition, although the causes of this pattern are frequently indistinguishable at radiologic evaluation, differences in the location of the characteristic attenuation in the lungs, as well as the presence of additional radiologic findings, the patient's history, and the clinical presentation, can often be useful in suggesting the appropriate diagnosis.

Pneumonia is one of the major infectious diseases responsible for significant morbidity and mortality throughout the world. Imaging plays a crucial role in the detection and management of patients with pneumonia. This review article discusses the different imaging methods used in the diagnosis and management of suspected pulmonary infections. The imaging examination should always begin with conventional radiography. When the results of routine radiography are inconclusive, computed tomography is mandatory. A combination of pattern recognition with knowledge of the clinical setting is the best approach to the pulmonary infectious processes.A specific pattern of involvement can suggest a likely diagnosis in many instances. In acquired immune deficiency syndrome patients, diffuse ground-glass and interstitial infiltrates are most commonly present in Pneumocystis carinii pneumonia whereas in the nonimmunosuppressed patients, a segmental lobar infiltrate is suggestive of a bacterial pneumonia. Round pneumonia is most often encountered in children than adults and is most often caused by Streptococcus pneumoniae. Different combinations of parenchymal and pleural abnormalities may be suggestive for additional diagnoses.When an infectious pulmonary process is suspected, knowledge of the varied radiographic manifestations will narrow the differential diagnosis, helping to direct additional diagnostic measures, and serving as an ideal tool for follow-up examinations.

The aspiration of different substances into the airways and lungs may cause a variety of pulmonary complications. These disease entities most commonly involve the posterior segment of the upper lobes and the superior segment of the lower lobes. Esophagography and computed tomography (CT) are especially useful in the evaluation of aspiration disease related to tracheoesophageal or tracheopulmonary fistula. Foreign body aspiration typically occurs in children and manifests as obstructive lobar or segmental overinflation or atelectasis. An extensive, patchy bronchopneumonic pattern may be observed in patients following massive aspiration of gastric acid or water. CT is the modality of choice in establishing the diagnosis of exogenous lipoid pneumonia, which can result from aspiration of hydrocarbons or of mineral oil or a related substance. Aspiration of infectious material manifests as necrotizing consolidation and abscess formation. The relatively low diagnostic accuracy of chest radiography in aspiration diseases can be improved with CT and by being familiar with the clinical settings in which specific complications are likely to occur. Recognition of the varied clinical and radiologic manifestations of these disease entities is imperative for prompt, accurate diagnosis, resulting in decreased morbidity and mortality rates.

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