Viral Pneumonias in Adults: Radiologic and Pathologic Findings

Abstract

Numerous viruses, including influenza virus, measles virus, Hantavirus, adenovirus, herpesviruses, varicella-zoster virus, cytomegalovirus, and Epstein-Barr virus, can cause lower respiratory tract infection in adults. Viral pneumonia in adults can be classified into two clinical groups: so-called atypical pneumonia in otherwise healthy hosts and viral pneumonia in immunocompromised hosts. Influenza virus types A and B cause most cases of viral pneumonia in immunocompetent adults. Immunocompromised hosts are susceptible to pneumonias caused by cytomegalovirus, herpesviruses, measles virus, and adenovirus. The radiographic findings, which consist mainly of patchy or diffuse ground-glass opacity with or without consolidation and reticular areas of increased opacity, are variable and overlapping. Computed tomographic findings, which are also overlapping, consist of poorly defined centrilobular nodules, ground-glass attenuation with a lobular distribution, segmental consolidation, or diffuse ground-glass attenuation with thickened interlobular septa. The radiologic findings reflect the variable extents of the histopathologic features: diffuse alveolar damage (intraalveolar edema, fibrin, and variable cellular infiltrates with a hyaline membrane), intraalveolar hemorrhage, and interstitial (intrapulmonary or airway) inflammatory cell infiltration. Clinical information such as patient age, immune status, community outbreaks, symptom onset and duration, and presence of a rash remain important aids in diagnosis of viral causes.

Outbreak of Febrile Respiratory Illness Caused by Adenovirus at a South Korean Military Training Facility: Clinical and Radiological Characteristics of Adenovirus Pneumonia

“…Thin-section CT images of 11 patients with pneumonia revealed that 2 had diffuse bronchopneumonia, 1 had GGO, and the rest showed consolidation patterns. Although viral pneumonia is typically represented radiologically as poorly defined nodules and patchy areas of peribronchial GGO and air-space consolidation, other studies on adenovirus pneumonia in soldiers and children revealed lobar consolidation patterns, as seen in the present study (21,(28)(29)(30). However, we were able to detect more specific segments of lung infiltration than previous studies, indicating right lower lobe involvement (54.6z).…”

Reading Room Electives: Say Goodbye to the “Radi-Holiday”

“…• "Spectrum of Blunt Chest Injuries" [21]; and • "Viral Pneumonias in Adults: Radiologic and Pathologic Findings" [22].…”

Síndrome pulmonar e cardiovascular por hantavírus: aspectos clínicos de uma doença emergente no sudeste brasileiro

“…Dois pacientes apresentaram derrame pleural bilateral após D4, denotando piora do quadro congestivo. Com base no quadro radiológico, outros autores chamam atenção para um diagnóstico diferencial com outras causas de Pneumonia Atípica em pacientes imunocompetentes, como aquela pelos vírus Influenza tipos A e B. Quanto a pacientes imunocomprometidos, o quadro radiológico de SPCVH poderia ser confundido com pneumonias por fungos como o Pneumocistis carinii e o histoplasma, além daquelas de etiologia viral, por citomegalovírus, herpesvírus, vírus do sarampo e adenovírus 14 .…”

“…Os achados radiológicos pulmonares da SPCVH descritos como semelhantes aos encontrados em outras viroses, como influenzas, sarampo, adenoviroses, herpesviroses, varicella-zoster e citomegaloviroses 14 . No período inicial, apresenta opacidade peri-hilar e basal e acentuação lateral das fissuras.…”