HTLV-1 is an etiologic retrovirus of adult T-cell leukemia or lymphoma (117,119). Influenza virus types A and B account for most viral pneumonias in immunocompetent adults (5). Perez-Padilla et al (86) reported bilateral patchy pneumonia in 18 patients with proved swine-origin influenza A virus; 12 of the 18 patients required mechanical ventilation and seven died. MERS coronavirus is a new member of the β-coronaviruses and is different from SARS and other endemic human β-coronaviruses (eg, OC43, HKU1). McGuinness et al (173) described the thin-section CT findings in 21 patients with AIDS and CMV pneumonia. Herein, emphasis was placed on the commonest imaging features of some of the most common viruses that produce pulmonary disease. In a previous study, Pavia (1) suggested that biphasic patterned illness, consolidation on chest radiographs, and high inflammation markers may increase the likelihood of bacterial coinfection (1). The characteristic radiographic manifestations consist of bilateral, multiple thin-walled cysts and nodules. A rapidly fatal adenovirus necrotizing pneumonia, early in the posttransplantation course, may occur in the pediatric population (153). Even with intensive laboratory investigation, the specific microbiologic cause can be established with certainty only in approximately 50% of patients with pneumonia. 27, No. Figure 3b. Coxsackievirus, echovirus, and enterovirus.—Coxsackievirus is a RNA virus, genus Enterovirus. Varicella pneumonia is estimated to occur in one of every 400 cases of adulthood chickenpox infections, being more common in pregnant and immunosuppressed patients (16). Viruses are the most common causes of respiratory infection. 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. Antiviral therapy can reduce attack rates and decrease outbreaks and could reduce the public health burden. HMPV was first identified in 2001; the structure of the virus is similar to that of RSV, and this virus can cause upper and lower respiratory tract infection. Influenza virus diffusely invades the respiratory epithelium, resulting in necrotizing bronchitis and diffuse alveolar damage, which manifest as consolidation (8). In immunocompetent adults, RSV infection usually manifests with rhinorrhea, pharyngitis, cough, bronchitis, headache, fatigue, and fever. Schemas show typical CT patterns of viral pneumonia. Figure 12a. 34, No. By considering both the clinical and radiologic characteristics, radiologists can suggest the diagnosis of viral pneumonia. The viruses usually appear as multifocal patchy consolidation with GGO, and centrilobular nodules with bronchial wall thickening are also noticed. Hilar lymphadenopathy and pleural effusion are unusual but may also be present. 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. Although CMV antigenemia assay has been a major advance in the diagnosis of CMV infection in organ transplantation (167), recent evaluations of reverse transcriptase PCR have revealed that PCR and antigenemia assay could provide false-negative results when virus levels are quite low (168). Figure 11: Transverse thin-section CT scan at the level of the aortic arch in a patient with parainfluenza virus infection shows bilateral ground-glass opacities and bronchial wall thickening (arrows). 4, 5 June 2020 | RadioGraphics, Vol. 6, Radiology of Infectious Diseases, Vol. SARS coronavirus was identified as a member of the family Coronaviridae in late 2003 after a world-wide epidemic. Figure 9b. Most infections are not associated with pneumonia. The most common method is the demonstration of measles virus–specific IgM in a single serum sample, but a more than fourfold titer increase in paired serum samples is also formal proof of a recent measles virus infection. (a) Initial chest radiograph shows multinodular airspace opacity (arrows) in the right lung. 40, No. These pulmonary findings are occasionally secondary to renal failure (59). 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CT: Unifocal GGO (arrow). Although the radiologic manifestations of viral pneumonia are nonspecific and difficult to differentiate from those of other infections, it … 84, No. The value of PCR in identifying respiratory viruses in clinical samples has been clearly shown, and as much as a three- to fourfold increase in positive specimens has been found when PCR testing is added to conventional cell culture and/or “standard” serologic methods. (a) Initial chest radiograph shows extensive patchy consolidation (arrows) with air bronchogram (arrowheads) in both lungs, especially in the middle to lower lung zones. Case 1. Pneumonia is a potential complication of COVID-19. Figure 13b. MERS coronavirus can evade immune response and cause a severe dysregulation of the host cellular transcriptome, resulting in apoptosis of cells (72). There was a good correlation between the size of the nodules and their origin. Adenovirus infections in immunocompromised individuals (eg, stem cell and solid organ transplant recipients) are increasingly recognized as substantial causes of morbidity and mortality. Pulmonary interstitial edema can be striking, although it usually is transient. Figure 4c. 6, Clinics in Chest Medicine, Vol. (a) Initial chest radiograph shows poorly defined nodules (arrows) and reticular areas of increased opacity in both lungs. Although some of these patterns may be relatively unique to a specific clinical context, others are nonspecific with respect to either the cause or pathogenesis. Pneumonia due to HSV in a 72-year-old woman with multiple myeloma. The CT signs of pulmonary viral infection will depend on the underlying pathologic process. (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. [10] Xu X. , et al., Evolution of the novel corona virus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission, Science China Life Sciences 63(3) (2020), 457–460. 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Bats and dromedary camels are considered to be reservoirs of MERS coronavirus. (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). Photomicrograph (hematoxylin-eosin stain; original magnification, ×100) shows interstitial widening with formation of micronodules (arrows). In hematopoietic stem cell transplant recipients, HPIV pneumonia exhibits 50% mortality during early stages and 75% 6-month mortality. (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. In the context of pulmonary infectious diseases, coexisting thickening of the interstitium and partial filling of the airspaces may both contribute to ground-glass opacity and consolidation (Fig 7). Pneumonia due to CMV in a 28-year-old man with graft-versus-host disease after bone marrow transplantation for chronic myeloblastic leukemia. Human parainfluenza virus is genetically and antigenically divided into types 1–4. CT usually shows 1–10-mm well-defined or ill-defined nodules with a surrounding halo of GGO, patchy GGO, and coalescence of nodules diffusely throughout both lungs. From the Department of Radiology and Research Institute of Radiology (H.J.K., J.C., K.H.D. (c) Pneumonia due to HMPV shows multiple ill-defined nodules (arrows) or GGO (arrowhead) along the bronchovascular bundles in both lungs. Intensive medical treatment was performed and the patient recovered. Figure 2: Histopathologic features of respiratory syncytial virus (RSV) bronchiolitis in a child. Pneumonia due to HMPV in a 50-year-old woman who presented with fever, cough, and sputum. Human bocavirus also is detected frequently in adults with mild respiratory symptoms. 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HTLV-1.—HTLV-1 is an RNA retrovirus. 2, Journal of Thoracic Imaging, Vol. 3, Korean Journal of Radiology, Vol. Viruses can result in several pathologic forms of lower respiratory tract infection, including tracheobronchitis, bronchiolitis, and pneumonia. The lesions may calcify, and well-defined scattered 2–3-mm hyperattenuating calcifications can persist (25). Moreover, coinfection with bacteria is common. Figure 11c. 8, American Journal of Roentgenology, Vol. (e) Pneumonia due to rhinovirus shows multiple ill-defined patchy areas of GGO (arrows) with interlobular septal thickening (arrowheads) in both lungs. (b–d) Axial CT images (3-mm section thickness) obtained on the same day at the level of the right inferior pulmonary vein (b) and the junction of the right atrium and inferior vena cava (c) and a coronal reconstruction image at the vertebral body level (d) show multifocal patchy and nodular consolidation with GGO (arrows) in both lower lobes. 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. Also, SARS coronavirus–encoded proteins induce cell apoptosis, including that of the lungs, kidneys, and liver. In bronchiolar disease, the regions of decreased attenuation seen in the lung at inspiration are also seen at expiration owing to air trapping and show little increase in attenuation or decrease in volume as seen with primary vascular lung disease (47,48) (Fig 6). For non-COVID-19 viral pneumonia and ... for automatic detection of COVID-19 pneumonia lung CT volumes and have ... available at this time for this novel virus [1, 2]. 2, No. Pneumonia, although rare, is the most serious complication affecting adults with chickenpox. Herein, emphasis was placed on the commonest imaging features of some of the most common viruses that produce pulmonary disease. (Image courtesy of T. Colby, MD, Mayo Clinic, Scottsdale, Ariz.). (c) Pneumonia due to HMPV shows multiple ill-defined nodules (arrows) or GGO (arrowhead) along the bronchovascular bundles in both lungs. 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. (a) Initial chest radiograph shows irregular ill-defined patchy increased opacity (arrows) in both lungs. The patient died despite intensive medical care. From 95 symptomatic patients confirmed with COVID-19 by RT-PCR from 1 May to 14 July 2020 in Dallah Hospital, Riyadh, Saudi Arabia, CT angiography was done for 25 patients suspected to have … Figure 23: Transverse thin-section CT scan at the level of the bronchus intermedius in a patient with herpesvirus infection shows multiple, bilateral, and randomly distributed pulmonary nodules surrounded by a halo of ground-glass opacity (arrows). Table 1 Summary of CT Findings in Viral Pneumonia. The symptoms of influenza begin rapidly with fever, usually 101°–102°F (38°–39°C), and is associated with myalgias, headache, lethargy, and respiratory tract symptoms of dry cough, rhinorrhea, and sore throat. After the patient underwent an emergency cesarean delivery, intubation and extracorporeal membrane oxygenation were performed for acute respiratory distress syndrome. These findings also disappear with healing of the skin lesions after antiviral therapy (24). Figure 13a. Figure 14: Coronal reformation multidetector CT scan in a 46-year-old man with swine-origin influenza A (H1N1) viral infection shows bilateral lobular and subsegmental areas of consolidation involving mainly the subpleural lung regions (arrowheads). Patients typically have a history of exposure and new infiltration of pneumonia on a chest radiograph. 2, No. 11, Respiratory Medicine Case Reports, Vol. 2, European Journal of Radiology, Vol. 22, No. The herpes group of viruses (herpes simplex, varicella-zoster, CMV, Epstein-Barr virus [EBV]) may cause focal cytopathic effects in either the airway or alveoli. Community outbreaks of adenovirus infection have been reported, and severe cases caused by adenovirus serotype 14 have been associated with older age, chronic underlying conditions, and low absolute lymphocyte counts (13,14). Pneumonia due to adenovirus in a 20-year-old man with fever, cough, and dyspnea. (c) Pneumonia due to HMPV shows multiple ill-defined nodules (arrows) or GGO (arrowhead) along the bronchovascular bundles in both lungs. Moreover, HMPV accounted for 9% of all acute respiratory infections in patients with hematologic malignancies, with a mortality rate of 11% in the subset of patients who developed lower respiratory infection (99). Most of those infected were previously healthy individuals. It is the first retrovirus to be associated with human disease (117). In other words, organizing pneumonia may result from a variety of causes or underlying pathologic processes, including viral infections. CT: Unifocal GGO (circle). Image from scanning low-power microscopy (hematoxylin-eosin stain; original magnification, ×20) shows nodular zones of necrosis, some of which are bronchiolocentric (arrows). (a) Initial chest radiograph shows ill-defined diffuse reticular areas of increased opacity (arrows) in both lungs. Signs and symptoms of infection included fever, cough, diarrhea, shortness of breath, lymphocytopenia, and thrombocytopenia. (a) Initial chest radiograph shows irregular ill-defined patchy increased opacity (arrows) in both lungs. (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. The editor and the reviewers indicated that they have no relevant relationships to disclose. A recent prospective study (47) showed that RSV was the most common viral pathogen (28%) in children hospitalized for community-acquired pneumonia in the United States. Figure 25: Coronal thin-section CT scan obtained with a multidetector unit in a 41-year-old man with CMV infection after hematopoietic stem cell transplantation shows multiple, bilateral, and randomly distributed small ill-defined pulmonary nodules, some of which are surrounded by a halo of ground-glass opacity (arrow). 1, Journal of Computer Assisted Tomography, Vol. Pulmonary parenchymal involvement during the course of HMPV pneumonia infection may result in interstitial lung disease and fibrosis. Children typically present with rhinorrhea, fever exceeding 100.4°F (>38°C), nonproductive cough, progressive dyspnea, hypoxemia, and bronchiolitis. (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). Viral respiratory tract infection is a broad term given to pulmonary infection caused by viruses. Figure 13c. (Images courtesy of Loren Ketai, MD, Albuquerque, NM.). (b) Frontal chest radiograph obtained 6 hours later demonstrates rapid progression to diffuse perihilar and lower lung consolidation, reflecting associated diffuse alveolar damage. The histologic features of herpes simplex lower respiratory tract infection include necrosis of the airway epithelium, necrotizing pneumonia as the reaction spreads from the airways to the adjacent parenchyma, diffuse alveolar damage, miliary nodules, and scattered larger nodules (15) (Fig 3). The virus was first isolated from the Hubei and Henan provinces in central China in 2010 and has since been reported in South Korea and Japan, mostly arising as sporadic cases in the spring and summer (52–54). CT abnormalities indicating infection, but unsure whether COVID-19 is involved, like widespread bronchopneumonia, lobar pneumonia, septic emboli with ground glass opacities. Common findings include numerous nodular opacities measuring 5–10 mm in diameter, some with a surrounding halo of ground-glass opacity (halo sign), patchy ground-glass opacities, and coalescence of nodules (162) A miliary distribution may also occur (162,163). HMPV pneumonia accounts for 4% of community-acquired pneumonia in immunocompetent adults and is prevalent during winter months.