대한흉부영상의학회 Weekly Chest Cases

Case No : 917 Date 2015-05-25

Courtesy of Hyun Jung Yoon, Yo Won Choi, Seok Chol Jeon / Hanyang University Hospital
Age/Sex 58 / M
Chief ComplaintSkin rashes and fever

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Diagnosis With Brief Discussion

Diagnosis: Varicella-zoster pneumonia
Radiologic Findings: CT scan demonstrates 5-10 mm sized, ill-defined nodules with peripheral ground glass attenuation halo in both lungs without zonal predominance.
Brief Review: Varicella-zoster pneumonia is regarded as the most serious manifestation of disseminated varicella-zoster virus infection. Reported incidences of varicella-zoster pneumonia have varied from less than 5% to up to 50% of all cases of varicella infection in adults. More than 90% of cases of varicella-zoster pneumonia occur in adults, in patients with lymphoma, and in those who are immunocompromised for a variety of reasons.
Symptoms of pneumonia develop within a few days after the skin rash appears and include cough, dyspnea, hemoptysis, tachypnea, pleuritic chest pain, cyanosis, and fever. Analysis of case series suggests that mortality due to varicella pneumonia has declined with the advent of acyclovir, although it remains as high as 22% in immunocompromised hosts.
The diagnosis of varicella-zoster pneumonia rests on the finding of new pulmonary infiltrates in the context of active chickenpox infection. Alternative causes for pulmonary infiltrates should be sought and excluded. The finding of viral inclusion bodies on histology provides strong supporting evidence for the diagnosis of varicella-zoster pneumonia.
Chest radiography findings in varicella-zoster pneumonia are well described and include pulmonary nodules, consolidation, hilar lymphadenopathy, and pleural effusions. Chest CT findings previously described as the development of multiple 5- to 10-mm ill-defined nodules that may be confluent and may come and go in different areas of the lungs. The small, round consolidations usually resolve within a week after the disappearance of the skin lesions, but they can persist for months.
There is a report of CT findings of varicella pneumonia that developed as the consequence of primary varicella infection occurring in a double lung transplant recipient, and the CT findings were marked mediastinal lymphadenopathy and interlobular septal thickening which are previously undescribed in varicella pneumonia. These differences may be a peculiarity of varicella pneumonia occurring in transplanted lungs. However, the CT characteristics of varicella pneumonia have been infrequently described; thus, it is probable that many of the features seen in this case may also be observed in non-immunosuppressed, non-lung transplantation patients.
Please refer to
References: 1. Kim JS, Ryu CW, Lee SI, Sung DW, Park CK. High-resolution CT findings of varicella-zoster pneumonia. AJR 1999;172:113-116
2. Maher TM, Gupta NK, Burke MM, Carby MR. CT findings of varicella pneumonia after lung transplantation. AJR Am J Roentgenol. 2007;188:W557-W559
Keywords: Lung, Infection, Viral infection,

No. of Applicants : 96

▶ Correct Answer : 25/96, 26.0%

- Armed Force Seoul Hospital , Korea (South) Eui Jin Hwang
- Juntendo University Hospital , Japan Akifumi Hagiwara
- Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- radiologist, aditya imaging centre , India vivek patel
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- Chonnam national university hospital , Korea (South) Jong-hyeon Kim
- Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
- Ajou University hospital , Korea (South) Hun Cho
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Seoul university hospital , Korea (South) Youngjin Ryu
- Niigata University , Japan Atsushi Uehara
- Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- NIMS, HYDERABAD , India bhaskar kakarla
- Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
- Fortis hospital , Mohali , India Shaleen Rana
- Onomichi municipal hospital , Japan Hirofumi Mifune
- Gifu Central Hospital , Japan Haruo Watanabe
- 遺 , Korea (South) LEE YOU JIN
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- SMG - SNU Boramae Medical Center , Korea (South) Ye Ra Choi
- Nasaret Hospital , Korea (South) Hee Seok Choi
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 9/96, 9.4%

- Oita University, Faculty of Medicine , Japan Fumito Okada
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Seoul National University Hospital , Korea (South) Hyoung-In Choi
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Niigata City General Hospital , Japan Takao Kiguchi
- CHU Poitiers , France CHAN paul
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Kizawa Memorial Hospital , Japan Shoji Okuda

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 917 Date 2015-05-25

Discussion

No. of Applicants : 96