CT Manifestations of Respiratory Syncytial Virus Infection in Lung Transplant Recipients

Ko, Jane P.; Shepard, Jo-Anne O.; Sproule, Michael; Trotman‐Dickenson, Beatrice; Drucker, Elizabeth A.; Ginns, Leo C.; Wain, John C.; McLoud, Theresa C.

doi:10.1097/00004728-200003000-00009

Cited by 44 publications

(25 citation statements)

References 17 publications

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“…In contrast, the percentage of such cases was 14 % in the study by Ko et al [16] and in the present study and 20 % in the studies by Escuissato et al [14] and Gasparetto et al [4]. All negative CT scans in the present study were reconstructed with a slice thickness of 3 mm.…”

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confidence: 64%

“…The following parameters were taken into consideration: which change could be detected from the beginning, which new parenchymal patterns occurred, what was the extent of any new parenchymal patterns. The current literature includes a study by Ko et al [16] who also used CT to examine the course of RSV pneumonias. The collective of 7 patients in this study included lung transplant recipients.…”

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confidence: 99%

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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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confidence: 64%

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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“…They may cause, however, mild respiratory illness particularly in the pediatric patients [35,36]. Ground-glass opacities are seen in almost 70% of the patients [39]. Cases with severe pneumonia and recovery in about one-third of them after treatment with aerosolized ribavirin have been reported [35,[40][41][42].…”

Section: Epidemiology and Preventionmentioning

confidence: 99%

Epidemiology and Management of Infections after Lung Transplantation

2001

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Lung transplantation has become an accepted treatment for end-stage pulmonary parenchymal and vascular diseases. Infections still are the most common cause of early and late morbidity and mortality in lung transplant recipients. Bacterial infections comprise approximately half of all infectious complications. Cytomegalovirus (CMV) infections and disease have become less frequent, because of prophylaxis with ganciclovir. Because CMV is also involved in the pathogenesis of obliterative bronchiolitis, the frequency of this infection may also reduce the occurrence of this main obstacle to successful lung transplantation. Invasive fungal infections remain a problem, but they have also decreased in frequency because of better control of risk factors such as CMV disease and preemptive antifungal therapy. Nonherpes respiratory viral infections have emerged as a serious problem. Their severity may be reduced by treatment with ribavirin. Meticulous postoperative surveillance, however, is still crucial for the management of lung transplant patients with respect to early detection and treatment of rejection and infection.

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“…It occurs in up to 50% of recipients and usually manifests itself between 9 -15 months (range 60 days -5.6 yrs) after transplantation [63,64]. It is probable that subclinical damage to small airways epithelium (secondary to acute rejection and/or cytomegalovirus (CMV) infection) occurs earlier, within the first few weeks following transplantation, and that subtle HRCT abnormalities caused by, for example, CMV infection [65] may predate the functional abnormalities of supervening small airways obliteration [66]. The contribution of imaging to the detection of acute rejection in these circumstances is limited, but the identification of areas of ground-glass opacification on HRCT within the first few months after transplantation is suggestive although nonspecific [67].…”

Section: Constrictive (Obliterative) Bronchiolitismentioning

confidence: 99%

Small airways diseases: detection and insights with computed tomography

Dm¹

2001

Eur Respir J

146

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Diseases affecting the small airways are difficult to detect by traditional diagnostic tests. Widespread involvement is needed before symptoms and abnormalities on pulmonary function testing or chest radiography become apparent. Obstruction of the bronchioles may be detected indirectly by computed tomography (CT) because regional under-ventilation results in reduced perfusion which in turn is shown as a mosaic attenuation pattern of the lung parenchyma. When there is inflammation of the bronchioles with accompanying exudate, the airways may become directly visible on CT, for example in cases of diffuse panbronchiolitis.Quantification of the various morphological features of small airways disease is possible from CT images and this increased precision has aided investigations of structure/function relationships.An understanding of the pathology and microscopic distribution of disease in relation to the airways allows some prediction of the likely computed tomography appearances in this wide spectrum of conditions, and thus helps to refine the differential diagnosis.

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CT Manifestations of Respiratory Syncytial Virus Infection in Lung Transplant Recipients

Abstract: During acute infection, patients commonly had ground-glass opacities but lacked pleural effusions and lymph node enlargement. There can be chronic sequelae after infection.

Cited by 44 publications

References 17 publications

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

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

Epidemiology and Management of Infections after Lung Transplantation

Small airways diseases: detection and insights with computed tomography

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