Korean J Radiol.  2016 Dec;17(6):940-949. 10.3348/kjr.2016.17.6.940.

Clinical Features and Radiological Findings of Adenovirus Pneumonia Associated with Progression to Acute Respiratory Distress Syndrome: A Single Center Study in 19 Adult Patients

• Cha MJ
• Chung MJ
• Lee KS
• Kim TJ
• Kim TS
• Chong S
• Han J

• KMID: 2466291
• DOI: http://doi.org/10.3348/kjr.2016.17.6.940

Abstract

OBJECTIVE
To describe radiologic findings of adenovirus pneumonia and to understand clinico-radiological features associated with progression to acute respiratory distress syndrome (ARDS) in patients with adenovirus pneumonia.
MATERIALS AND METHODS
This study included 19 patients diagnosed with adenovirus pneumonia at a tertiary referral center, in the period between March 2003 and April 2015. Clinical findings were reviewed, and two radiologists assessed imaging findings by consensus. Chi-square, Fisher's exact, and Student's t tests were used for comparing patients with and without subsequent development of ARDS.
RESULTS
Of 19 patients, nine were immunocompromised, and 10 were immunocompetent. Twelve patients (63%) progressed to ARDS, six of whom (32%) eventually died from the disease. The average time for progression to ARDS from symptom onset was 9.6 days. Initial chest radiographic findings were normal (n = 2), focal opacity (n = 9), or multifocal or diffuse opacity (n = 8). Computed tomography (CT) findings included bilateral (n = 17) or unilateral (n = 2) ground-glass opacity with consolidation (n = 14) or pleural effusion (n = 11). Patients having subsequent ARDS had a higher probability of pleural effusion and a higher total CT extent compared with the non-ARDS group (p = 0.010 and 0.007, respectively). However, there were no significant differences in clinical variables such as patient age and premorbid condition.
CONCLUSION
Adenovirus pneumonia demonstrates high rates of ARDS and mortality, regardless of patient age and premorbid conditions, in the tertiary care setting. Large disease extent and presence of pleural effusion on CT are factors suggestive of progression to ARDS.

Keyword

Adenovirus; Pneumonia; Acute respiratory distress syndrome; Chest radiograph; CT

MeSH Terms

Acute Disease
Adenoviridae/isolation & purification
Adult
Aged
Disease Progression
Female
Humans
Immunocompromised Host
Male
Middle Aged
Pneumonia, Viral/complications/*diagnosis/diagnostic imaging/virology
Radiography
Respiratory Distress Syndrome, Adult/*diagnosis/etiology
Retrospective Studies
Tertiary Care Centers
Thorax/diagnostic imaging
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 20-year-old immunocompetent man complaining of fever, dyspnea, productive cough, and sputum. He visited our hospital on 10th day from onset of his symptoms, which were abruptly aggravated two days prior. A. Chest radiograph demonstrates multifocal or diffuse opacity. B. Chest CT scan obtained on same day demonstrates extensive airspace lesions in both lungs, with bilateral pleural effusions. Total CT score was 13. Culture of BAL fluid helped confirm adenovirus pneumonia. On next day, patient was transferred to intensive care unit, and he eventually expired on 21st day of hospitalization. BAL = bronchoalveolar lavage, CT = computed tomography

• 

  Fig. 2 38-year-old woman with acute myelogenous leukemia visited our institution for aggravated fever, cough, sputum, and dyspnea for four days. A. Chest radiograph at admission demonstrates subtle focal opacity in right upper lung zone (white arrow). B, C. Chest CT scans obtained on same day demonstrate patchy peribronchial ground-glass opacity in both lungs (black arrows). Total CT score was 3. Culture and RT-PCR of BAL fluid confirmed adenovirus pneumonia. D. Follow-up chest radiograph obtained after two weeks of treatment with cidofovir demonstrates disappearance of focal opacity in right upper lung zone, suggesting type 1 disease pattern. BAL = bronchoalveolar lavage, CT = computed tomography, RT-PCR = reverse transcription polymerase chain reaction

• 

  Fig. 3 20-year-old immunocompetent man suffering from acute fever and dyspnea. A. Chest radiograph obtained on fifth day of illness demonstrates focal opacity in left lower lobe (arrow). B, C. Chest CT scans demonstrate dense consolidation and ground-glass opacity in left lower lobe (arrow). Small left pleural effusion is indicated by open arrow. Total CT score was 7. D. Chest radiograph obtained on seventh day of illness demonstrates increased amount of left pleural effusion and bilateral multifocal areas of parenchymal opacity. E. Progressive diffuse opacity in both lungs and bilateral pleural effusions are shown on follow-up radiograph taken on 13th day, suggesting ARDS and type 4 disease pattern. Patient expired on 16th day of illness. ARDS = acute respiratory distress syndrome, CT = computed tomography

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