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Viral Chest Infection
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        TERMINOLOGY

        • Definitions

          • Terminology varies, can be confusing
          • Bronchiolitis (per American Academy of Pediatrics): Viral lower respiratory tract infection in infants affecting small airways with inflammation, edema, & epithelial necrosis
          • Lower respiratory tract infection may describe findings identical to bronchiolitis in patients ≥ 2 years old but may also refer to any infection of lower airways & parenchyma
          • Viral pneumonia may refer to viral infection of lung parenchyma ± airways
          • Peribronchial pneumonia is sometimes used to differentiate airways infection from parenchymal involvement
          • Lower airways disease includes viral airways infection as well as asthma

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • General Features of Epidemic & Pandemic Pathogens

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      CLINICAL ISSUES

                      • Presentation

                        • Demographics

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                Selected References

                                1. Foust AM et al: Pediatric SARS, H1N1, MERS, EVALI, and now Coronavirus disease (COVID-19) pneumonia: what radiologists need to know. AJR Am J Roentgenol. 215(3):736-44, 2020
                                2. Koo HJ et al: Radiographic and CT features of viral pneumonia. Radiographics. 38(3):719-39, 2018
                                3. Niles D et al: Retrospective review of clinical and chest x-ray findings in children admitted to a community hospital for respiratory syncytial virus infection. Clin Pediatr (Phila). 57(14):1686-92, 2018
                                4. Hilmes MA et al: Chest radiographic features of human metapneumovirus infection in pediatric patients. Pediatr Radiol. 47(13):1745-50, 2017
                                5. Winant AJ et al: Current updates on pediatric pulmonary infections. Semin Roentgenol. 52(1):35-42, 2017
                                6. Jain S et al: Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 372(9):835-45, 2015
                                7. Rhedin S et al: Respiratory viruses associated with community-acquired pneumonia in children: matched case-control study. Thorax. 70(9):847-53, 2015
                                8. Ralston SL et al: Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 134(5):e1474-502, 2014
                                9. Bradley JS et al: Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 53(7):617-30, 2011
                                10. Franquet T: Imaging of pulmonary viral pneumonia. Radiology. Jul;260(1):18-39, 2011
                                11. Ruuskanen O et al: Viral pneumonia. Lancet; 377(9773):1264-75, 2011
                                12. Yoo SY et al: H1N1 influenza infection in children: frequency, pattern, and outcome of chest radiographic abnormalities. Clin Radiol. 66(4):334-9, 2011
                                13. Bramson RT et al: Interpretation of chest radiographs in infants with cough and fever. Radiology. 236(1):22-9, 2005
                                14. Copley SJ: Application of computed tomography in childhood respiratory infections. Br Med Bull. 61:263-79, 2002
                                15. Kim EA et al: Viral pneumonias in adults: radiologic and pathologic findings. Radiographics. 22 Spec No:S137-49, 2002
                                16. Virkki R et al: Differentiation of bacterial and viral pneumonia in children. Thorax. 57(5):438-41, 2002
                                17. Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
                                18. Juven T et al: Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 19(4):293-8, 2000
                                19. Markowitz RI et al: The spectrum of pulmonary infection in the immunocompromised child. Semin Roentgenol. 35(2):171-80, 2000
                                20. Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
                                21. Katz DS et al: Radiology of pneumonia. Clin Chest Med. 20(3):549-62, 1999
                                22. Donnelly LF et al: The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998
                                23. Wahlgren H et al: Radiographic patterns and viral studies in childhood pneumonia at various ages. Pediatr Radiol. 25(8):627-30, 1995
                                24. Korppi M et al: Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr. 82(4):360-3, 1993
                                25. Kirkpatrick JA: Pneumonia in children as it differs from adult pneumonia. Semin Roentgenol. 15(1):96-103, 1980
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Clinical Issues

                                      TERMINOLOGY

                                      • Definitions

                                        • Terminology varies, can be confusing
                                        • Bronchiolitis (per American Academy of Pediatrics): Viral lower respiratory tract infection in infants affecting small airways with inflammation, edema, & epithelial necrosis
                                        • Lower respiratory tract infection may describe findings identical to bronchiolitis in patients ≥ 2 years old but may also refer to any infection of lower airways & parenchyma
                                        • Viral pneumonia may refer to viral infection of lung parenchyma ± airways
                                        • Peribronchial pneumonia is sometimes used to differentiate airways infection from parenchymal involvement
                                        • Lower airways disease includes viral airways infection as well as asthma

                                      IMAGING

                                      • General Features

                                        • Radiographic Findings

                                          • CT Findings

                                            • General Features of Epidemic & Pandemic Pathogens

                                              • Imaging Recommendations

                                                DIFFERENTIAL DIAGNOSIS

                                                  PATHOLOGY

                                                  • General Features

                                                    CLINICAL ISSUES

                                                    • Presentation

                                                      • Demographics

                                                        • Natural History & Prognosis

                                                          • Treatment

                                                            DIAGNOSTIC CHECKLIST

                                                            • Consider

                                                              Selected References

                                                              1. Foust AM et al: Pediatric SARS, H1N1, MERS, EVALI, and now Coronavirus disease (COVID-19) pneumonia: what radiologists need to know. AJR Am J Roentgenol. 215(3):736-44, 2020
                                                              2. Koo HJ et al: Radiographic and CT features of viral pneumonia. Radiographics. 38(3):719-39, 2018
                                                              3. Niles D et al: Retrospective review of clinical and chest x-ray findings in children admitted to a community hospital for respiratory syncytial virus infection. Clin Pediatr (Phila). 57(14):1686-92, 2018
                                                              4. Hilmes MA et al: Chest radiographic features of human metapneumovirus infection in pediatric patients. Pediatr Radiol. 47(13):1745-50, 2017
                                                              5. Winant AJ et al: Current updates on pediatric pulmonary infections. Semin Roentgenol. 52(1):35-42, 2017
                                                              6. Jain S et al: Community-acquired pneumonia requiring hospitalization among U.S. children. N Engl J Med. 372(9):835-45, 2015
                                                              7. Rhedin S et al: Respiratory viruses associated with community-acquired pneumonia in children: matched case-control study. Thorax. 70(9):847-53, 2015
                                                              8. Ralston SL et al: Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 134(5):e1474-502, 2014
                                                              9. Bradley JS et al: Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 53(7):617-30, 2011
                                                              10. Franquet T: Imaging of pulmonary viral pneumonia. Radiology. Jul;260(1):18-39, 2011
                                                              11. Ruuskanen O et al: Viral pneumonia. Lancet; 377(9773):1264-75, 2011
                                                              12. Yoo SY et al: H1N1 influenza infection in children: frequency, pattern, and outcome of chest radiographic abnormalities. Clin Radiol. 66(4):334-9, 2011
                                                              13. Bramson RT et al: Interpretation of chest radiographs in infants with cough and fever. Radiology. 236(1):22-9, 2005
                                                              14. Copley SJ: Application of computed tomography in childhood respiratory infections. Br Med Bull. 61:263-79, 2002
                                                              15. Kim EA et al: Viral pneumonias in adults: radiologic and pathologic findings. Radiographics. 22 Spec No:S137-49, 2002
                                                              16. Virkki R et al: Differentiation of bacterial and viral pneumonia in children. Thorax. 57(5):438-41, 2002
                                                              17. Donnelly LF: Practical issues concerning imaging of pulmonary infection in children. J Thorac Imaging. 16(4):238-50, 2001
                                                              18. Juven T et al: Etiology of community-acquired pneumonia in 254 hospitalized children. Pediatr Infect Dis J. 19(4):293-8, 2000
                                                              19. Markowitz RI et al: The spectrum of pulmonary infection in the immunocompromised child. Semin Roentgenol. 35(2):171-80, 2000
                                                              20. Donnelly LF: Maximizing the usefulness of imaging in children with community-acquired pneumonia. AJR Am J Roentgenol. 172(2):505-12, 1999
                                                              21. Katz DS et al: Radiology of pneumonia. Clin Chest Med. 20(3):549-62, 1999
                                                              22. Donnelly LF et al: The yield of CT of children who have complicated pneumonia and noncontributory chest radiography. AJR Am J Roentgenol. 170(6):1627-31, 1998
                                                              23. Wahlgren H et al: Radiographic patterns and viral studies in childhood pneumonia at various ages. Pediatr Radiol. 25(8):627-30, 1995
                                                              24. Korppi M et al: Comparison of radiological findings and microbial aetiology of childhood pneumonia. Acta Paediatr. 82(4):360-3, 1993
                                                              25. Kirkpatrick JA: Pneumonia in children as it differs from adult pneumonia. Semin Roentgenol. 15(1):96-103, 1980