대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Varicella-Zoster Pneumonia in Chickenpox patient

Radiologic Findings

Chest radiograph shows multiple small nodules in both lungs. High-resolution CT scan demonstrates 5-10 mm sized, ill-defined nodules in both lungs without zonal predominance.

Brief Review

Chickenpox and herpes zoster are caused by varicella-zoster virus infection. Chicken pox (varicella) represent primary disease in previous uninfected individuals, and herpes zoster represent reactivation of latent virus.
Varicella-Zoster pneumonia is the most common complication of this viral infection and sometimes leads to death. The overall incidence of pneumonia in patients with chicken pox appears to be about 14%, but in adults admitted to the hospital it may be as high as 50%. Immunosuppressive conditions such as leukemia, malignant lymphoma, and corticosteroid therapy, or organ transplantation are the predisposed conditions to varicella-zoster pneumonia. Pregnancy, heavy smoking, old age, chronic obstructive pulmonary disease, and severe cutaneous rashes are also documented as risk factors.
On chest radiographs, the pneumonia causes 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. In a few patients, the lesions calcify and remain indefinitely as numerous, well defined, randomly scattered, 2- to 3-mm dense calcifications in otherwise normal lungs. Hilar adenopathy and pleural effusions may occur, but are unusual. Chest CT scan showed multiple, 5-10mm in diameter, nodules of soft tissue density containing no calcifications, bilaterally.

References

1. Jeung Sook Kim, Chan Woo Ryu, Seug Ik Lee, Dong Wook Sung, Choong Ki Park. High-Resolution CT findinings of Varicella-Zoster Pneumonia. AJR 1999;172:113
2. Fraser RG, Fraser RS, Pare JAP, Pare PD, Generics GP. Diagnosis of disease of the chest, 3rd ed. Philadelphia Saunders, 1989:1062-1068

Keywords

Lung, Infection, Viral infection,