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Weekly Chest CasesArchive of Old Cases

Case No : 1161 Date 2020-01-30

  • Courtesy of So Hyeon Bak, Heon Han / Kangwon National University Hospital
  • Age/Sex 49 / M
  • Chief ComplaintFever and skin rash
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Varicella-zoster pneumonia
Radiologic Findings
Fig. 1-5 Axial images of chest CT show randomly distributed, small, ill-defined nodules with a surrounding halo of ground glass opacity in both lungs. The patient showed skin rash. After antiviral therapy, the patient’s symptoms and lung nodules were considerably improved.
Brief Review
Varicella-zoster virus is a double stranded DNA virus that causes a self-limited benign disease (chickenpox) in children. However, infection of varicella-zoster virus tends to cause serious complications such as varicella-zoster pneumonia in adults with lymphoma and immunocompromised or pregnant patients. The diagnosis of varicella infection is usually based on clinical findings such as skin rash, pulmonary symptoms, and a history of contact with a patient with chickenpox. With recovery from the initial disease, spherical nodules are observed to be scattered randomly throughout the lung parenchyma. Histologically, the nodules are composed of an outer lamellated fibrous capsule that encloses hyalinized collagen or necrotic tissue. Chest CT findings of varicella-zoster pneumonia consist of 1-10 mm well-defined or ill-defined nodules with a surrounding halo of ground glass opacity and coalescence of nodules diffusely throughout both lungs. These finding resolve with the healing of skin lesions after antiviral therapy.
Please refer to
Case 79, Case 328, Case 917, Case 1109,
KSTR Imaging Conference 2003 Summer  Case 2,
References
1. Kim EA et al. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 2002;22:S137-S149
2. Koo HJ et al. Radiologic and CT features of viral pneumonia. Radiographics 2018;38:719-739
Keywords
lung, Varicella-Zoster pneumonia, Viral infection,

No. of Applicants : 78

▶ Correct Answer : 58/78,  74.4%
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - radiologist, aditya imaging centre , India VIVEK PATEL
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - , Saudi Arabia ALAAELDIN MOHAMED
  • - National cancer center hospital east , Japan SHIOTO ODA
  • - , Korea (South) HYEYOUNG CHOI
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - , Korea (South) CHOHEE KIM
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) HEE SEOK CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
  • - Cabinet Capricorne, clinique sainte-clotilde , Reunion FABIEN HO
  • - The Jikei university , Japan TAKU GOMI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - , Jordan HISHAM IBRAHIM KHATIB
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - Other , Korea (South) HONG SANG HYUP
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - , Korea (South) PARK JONGMIN
  • - Kyeongpook National University Hospital , Korea (South) HYEONJUN JANG
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Chungbuk National University Hospital , Korea (South) YOUNGHUN JEON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - chp st martin , France BENOIT HENR MARIOTTE
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Hallym University Dongtan Medical Center , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Ajou University Hospital , Korea (South) HYERIN KIM
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Asan Medical Center , Korea (South) JIHOON KIM
  • - Seoul Veterans Hospital , Korea (South) JANG SEONG WON
  • - TB centre kasaragod. , India rikhy krishnan
  • - Nishida Hospital , Japan SHOJI OKUDA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
  • - Xiamen third hospital , China LI JUN BIAO
  • - Private sector , Greece VASILIOS TZILAS
  • - , Japan YUMI MAEHARA
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - Chonnam National University Hwasun Hospital , Korea (South) WONGI JEONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Seoul National University Hospital , Korea (South) SEUNG JIN YOO
  • - Asan Medical Center , Korea (South) HYEMIN AHN
  • - Jiangsu province hospital , China WANGJIAN ZHA
  • - Ziad Fadhel Moqbel
▶ Correct Answer as Differential Diagnosis : 2/78,  2.6%
  • - Lille , France BENOIST CAPON
  • - , Nepal PETER BISTA
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