Respiratory Syncytial Virus Pneumonia

  • Etiology:
    — Respiratory syncytial virus infection leads to
    — Disease of airways and airway inflammation which leads to bronchial wall thickening which leads to ball-valve effect which leads to air trapping
    — Increased mucous production leads to mucous plugs
  • Imaging CXR:
    — Airway thickening
    — Hyperinflation = flattened diaphragm
    — Shifting subsegmental atelectasis from mucous plugs
  • Note: A normal CXR does not rule out viral pneumonia as CXR is insensitive to the detection of viral pneumonia
  • DDX: Viral pneumonia, congenital heart disease
  • Complications:
    — Bacterial superinfection
    — ~ 25% go on to develop reactive airway disease (asthma)
    — Rarely get pneumothorax
  • Treatment: Antivirals in some cases
  • Clinical:

Radiology Cases of Respiratory Syncytial Virus Pneumonia

CXR of respiratory syncytial virus pneumonia
CXR PA and lateral shows airway thickening and lung hyperexpansion with flattening of the hemidiaphragms.
CXR of respiratory syncytial virus pneumonia / RSV
CXR AP and lateral shows mild central airway thickening and mild lung hyperinflation bilaterally.
CXR of respiratory syncytial virus pneumonia / RSV
CXR AP and lateral (above) shows right upper lobe collapse and air outlining the inferior border of the heart (continuous diaphragm sign). Left lateral decubitus CXR (below) shows a small right pneumothorax.

Radiology Cases of Respiratory Syncytial Virus Pneumonia With Endotracheal Tube in the Right Mainstem Bronchus

CXR of endotracheal tube in right mainstem bronchus
CXR AP shows the tip of the endotracheal tube to be in the right mainstem bronchus. There is hyperaeration of the right lung.

Radiology Cases of Respiratory Syncytial Virus Pneumonia with Bacterial Suprainfection

CXR of viral pneumonia with a bacterial suprainfection
CXR shows diffuse airway thickening and hyperexpansion along with an infiltrate obscuring the right heart border and the medial hemidiaphragms bilaterally.