CT of Viral Lower Respiratory Tract Infections in Adults: Comparison Among Viral Organisms and Between Viral and Bacterial Infections

Miller, Wallace T.; Mickus, Timothy; Barbosa, Eduardo J. Mortani; Mullin, Christopher M.; Deerlin, Vivanna M. Van; Shiley, Kevin T.

doi:10.2214/ajr.11.6501

Cited by 112 publications

(88 citation statements)

References 23 publications

(12 reference statements)

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“…bronchitis, bronchiolitis, bronchopneumonia, focal or multifocal pneumonia as well as airway-centric vs. diffuse GGO) [16,17]. According to these earlier reports, we decided to further reduce the number of pneumonia infiltration patterns to only two "airway-centric" and "interstitial-parenchymal" predominant patterns looking first for potentially discriminatory features between the Influenza virus types and subtypes as well as between pneumonia occurring in immunocompetent vs. immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients

Kloth

Forler

Gatidis

et al. 2015

European Journal of Radiology

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Section: Discussionmentioning

confidence: 99%

Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients

Kloth

Forler

Gatidis

et al. 2015

European Journal of Radiology

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“…al [15] who retrospectively examined the CT-morphological characteristics of 115 community-acquired bacterial and viral (19 RSV) infections of the lower respiratory tract found the tree-in-bud pattern and bronchial wall thickening most frequently in association with RSV.…”

mentioning

confidence: 99%

CT-Morphological Characterization of Respiratory Syncytial Virus (RSV) Pneumonia in Immune-Compromised Adults

Mayer

Lehners

Egerer

et al. 2014

Fortschr Röntgenstr

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!Purpose: Characterization and follow-up evaluation of chest CT of RSV pneumonia in immune-compromised adults during a seasonal epidemic. Materials and Methods: Retrospective analysis of 132 chest CT examinations of 51 adult immune-compromised patients (29 m/22f, Ø58 years) with clinical signs of pneumonia and positive RSV test in winter 2011/2012. Two experienced chest radiologists evaluated the morphology (bronchial wall thickening, tree-in-bud, nodules, halo, ground-glass opacities, consolidations, pleural fluid) of the CT scans by consensus. Results: Pathological findings were in 86 % of the chest CT scans: Areas of ground-glass attenuation in 64 %, consolidations in 56 %, nodules in 55 % (Ø 8 mm in maximal diameter, with halo in 71 %), pleural fluid in 44 % (Ø 2 cm), tree-in-bud in 36 %, bronchial wall thickening in 27 % and more than one morphological finding in 72 %. There were no pathological CT findings in 14 % of patients with clinical symptoms of pneumonia because these patients did not undergo follow-up. Radiological progression was found in 45 % of patients and regression in 33 % in follow-up examinations. In 37 % an additional examination of the paranasal sinuses was performed and showed sinusitis in 63 % of cases. 90 % of the patients had sinusitis as well as pneumonia. In addition to RSV, a further pathogenic agent was found in bronchoalveolar lavage of five patients (Aspergillus spec., herpes simplex virus, Pseudomonas aeruginosa). Conclusion: The most characteristic signs in chest CT scans were at the beginning of pneumonia with nodules and tree-in-bud often combined with bronchial wall thickening. The following CT scans showed characteristic but not pathognomonic chest CT findings of RSV pneumonia. These morphological findings should be recognized seasonally (winter) especially at the beginning of the case of pneumonia. RSVassociated additional sinusitis is probably common and should be noticed. Key Points:▶ The most characteristic signs in chest CT scans were at the beginning of RSV pneumonia with nodules and tree-in-bud; we suppose that the pneumonia is run through different CT morphological phases.▶ The following CT scans showed less characteristic and multiple CT variations most frequently ground glass and nodules.▶ Negative thoracic CT were seen only in a little part of RSV positive patients with symptoms of pneumonia.

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“…27 Recent diagnostic tests, particularly polymerase chain reactions, have allowed more frequent identification of viral pathogens, which are probably present in 15% to 35% of lower respiratory tract infections among immunocompetent adults. 28,29 These viruses may be the sole causative organism but frequently occur as coinfections. On CT images, many viruses are as likely to appear as pneumonia as they are to appear as bronchiolitis/bronchitis.…”

Section: Differentiation Of Pneumonia From Noninfectious Diseasesmentioning

confidence: 99%

“…However, some viruses, such as respiratory syncytial virus (RSV) and parainfluenza, most commonly present with an airway centric pattern of disease. 29 Adenoviruses are more likely to cause confluent consolidation, particularly during outbreaks of immunologically novel strains. 30 Compared with its diagnostic role in bacterial and viral infections, CT abnormalities can be more specific for diagnosis of mycobacterial disease, and can serve as an adjunct to interferon gamma release assays.…”

Section: Differentiation Of Pneumonia From Noninfectious Diseasesmentioning

confidence: 99%

Imaging Infection

Ketai

Jordan

Busby

2015

Clinics in Chest Medicine

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Thoracic imaging is widely used to detect lower respiratory tract infections, identify their complications, and aid in differentiating infectious from noninfectious thoracic disease. Less commonly, the combination of imaging findings and a clinical setting can favor infection with a specific organism. This confluence can occur in cases of bronchiectatic nontuberculous mycobacterial infections in immune-competent hosts, invasive fungal disease among neutropenic patients, Pneumocystis jiroveci pneumonia in patients with AIDS, and in cytomegalovirus infections in patients with recent hematopoietic cell transplantation. These specific diagnoses often depend on computed tomography scanning rather than chest radiography alone.

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CT of Viral Lower Respiratory Tract Infections in Adults: Comparison Among Viral Organisms and Between Viral and Bacterial Infections

Abstract: There is considerable overlap in the imaging appearance of viral and bacterial respiratory infections. However, some characteristic differences can be seen, especially with RSV and adenovirus infections.

Cited by 112 publications

References 23 publications

Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients

Comparison of chest-CT findings of Influenza virus-associated pneumonia in immunocompetent vs. immunocompromised patients

CT-Morphological Characterization of Respiratory Syncytial Virus (RSV) Pneumonia in Immune-Compromised Adults

Imaging Infection

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