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Weekly Chest CasesArchive of Old Cases

Case No : 1348 Date 2023-08-22

  • Courtesy of Hyewon Choi / Chung-Ang University Hospital
  • Age/Sex 48 / F
  • Chief ComplaintFever, multiple erythematous vesicle, headache
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Varicella zoster pneumonia
Radiologic Findings
Fig 1-3. Multiple scattered ill-defined nodules in both lungs
Figure 4. Several tiny nodular skin lesions at covered upper abdomen and lower chest wall.
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 findings resolve with the healing of skin lesions after antiviral therapy.
Please refer to
Case 79, Case 328, Case 917, Case 1109, Case 1161,
References
Kim EA et al. Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 2002;22:S137-S149
Koo HJ et al. Radiologic and CT features of viral pneumonia. Radiographics 2018;38:719-739
Keywords

No. of Applicants : 85

▶ Correct Answer : 55/85,  64.7%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - The University of Tokyo Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - , Japan KYOKO NAGAI
  • - , France, Metropolitan ANASS IBRAHIM
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - CHCB , France LE GUEN RAPHAEL
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Chonnam National University Hospital , Korea (South) HYUNJIN KIM
  • - , France CHARLES DAMIEN
  • - Healthy Longevity Medical Center , Japan SHIN-ICHI CHO
  • - Chonnam National University Hwasun Hospital , Korea (South) DONGHUN HAN
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) BYUK GYUNG CHOI
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - Soonchunhyang University Hospital Bucheon , Korea (South) HYEJOO PARK
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - OITA UNIVERSITY , Japan FUMIKA ISHITOBI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Ajou University Hospital , Korea (South) JAYOUNG MOON
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Hukuda memorial hospital , Japan SHINTARO KANO
  • - Asan Medical Center , Korea (South) JIEUN KIM
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - , Japan SHUNJIRO NOGUCHI
  • - , Korea (South) HEONSEOK LEE
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Seoul National University Hospital , Korea (South) SUNGHO HONG
  • - Others , India PURUSHOTHAMA RAO TUMMALA
  • - Chonnam National University Hospital , Korea (South) GYERYEONG PARK
  • - Chonnam National University Hospital , Korea (South) KIM SANG GYUN
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - Hyogo Prefectural Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Chonnam National University Hospital , Korea (South) SEUNG WAN KANG
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Kyoto university , Japan AKIHIKO SAKATA
  • - Other , Korea (South) YONG HO JANG
  • - , Korea (South) JIN WOO YOON
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 2/85,  2.4%
  • - , Japan HIKARI FUKUI
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
▶ Semi-Correct Answer : 2/85,  2.4%
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
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