Korean J Radiol.  2000 Jun;1(2):73-78. 10.3348/kjr.2000.1.2.73.

Cytomegalovirus Pneumonia: High - Resolution CT Findings in Ten Non-AIDS Immunocompromised Patients

• Moon JH
• Kim EA
• Lee KS
• Kim TS
• Jung KJ
• Song JH

• KMID: 966476
• DOI: http://doi.org/10.3348/kjr.2000.1.2.73

Abstract

OBJECTIVE
To describe the HRCT findings of cytomegalovirus (CMV) pneumonia in non-AIDS immunocompromised patients. MATERIALS AND METHODS: This retrospective study involved the ten all non-AIDS immunocompromised patients with biopsy-proven CMV pneumonia and without other pulmonary infection encountered at our Medical Center between January 1997 and May 1999. HRCT scans were retrospectively analysed by two chest radiologists and decisions regarding the findings were reached by consensus. RESULTS: The most frequent CT pattern was ground-glass opacity, seen in all patients, with bilateral patchy (n = 8) and diffuse (n = 2) distribution. Other findings included poorly-defined small nodules (n = 9) and consolidation (n = 7). There was no zonal predominance. The small nodules, bilateral in eight cases and unilateral in one, were all located in the centrilobular region. Consolidation (n = 7), with patchy distribution, was bilateral in five of seven patients (71%). Pleural effusion and bilateral areas of thickened interlobular septa were seen in six patients (60%). CONCLUSION: CMV pneumonia in non-AIDS immunocompromised patients appears on HRCT scans as bilateral mixed areas of ground-glass opacity, poorly-defined centrilobular small nodules, and consolidation. Interlobular septal thickening and pleural effusion are frequently associated.

Keyword

Lung, abnormalities; Lung, CT; Lung, infection

MeSH Terms

Cytomegalovirus Infections/immunology/*radiography
Female
Human
Immunocompromised Host/*immunology
Male
Middle Age
Pneumonia, Viral/immunology/*radiography/virology
Retrospective Studies
Tomography, X-Ray Computed/*methods

Figure

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  Fig. 1 Cytomegalovirus pneumonia in a 27-year-old man who underwent kidney transplantation. High-resolution (1.0-mm collimation) CT scan obtained at level of distal trachea 32 days after transplantation shows bilateral patchy areas of ground-glass opacity with crazy paving appearance. The presence of a few poorly-defined centrilobular nodules (arrows) and bilateral pleural effusion should also be noted.

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  Fig. 2 Cytomegalovirus pneumonia in a 35-year-old woman who underwent bone marrow transplantation 27 days earlier. A. High-resolution (1.0-mm collimation) CT scan obtained at level of bronchus intermedius shows numerous small nodules predominantly in centrilobular regions (arrows). There are associated focal patchy areas of ground-glass opacity. B. Photomicrograph of transbronchial lung biopsy specimen obtained from superior segment of right lower lobe shows diffuse alveolar damage consisting of interstitial fibroblastic proliferation and type-2 pneumocyte hyperplasia (arrows), in addition to characteristic cells (arrowheads) showing intra-nuclear inclusions (H & E, ×100).

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  Fig. 3 Cytomegalovirus pneumonia in a 30-year-old woman who presented with fever two months after kidney transplantation. A. High-resolution (1.0-mm collimation) CT scan obtained at level of right inferior pulmonary vein shows mixed areas of ground-glass opacity and small poorly-defined centrilobular nodules (arrows). There is associated interlobular septal thickening (arrowheads). B. Photomicrograph of transbronchial lung biopsy specimen obtained from superior segment of right lower lobe shows intra-alveolar collection of macrophages, fibrin and red blood cells (arrows) that corresponds to the centrilobular nodules seen on CT scans. There is associated alveolar wall thickening, with interstitial inflammatory cell infiltration (H & E, ×200).

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