Respiratory Syncytial Virus Pneumonia

  • Etiology: 1) respiratory syncytial virus infection -> 2) disease of airways / airway inflammation -> bronchial wall thickening -> ball-valve effect -> air trapping, 3) increased mucous production -> mucous plugs
  • Imaging: airway thickening, hyperinflation = flattened diaphragm, shifting subsegmental atelectasis from mucous plugs
  • DDX: viral pneumonia, congenital heart disease
  • Complications: bacterial superinfection, ~ 25% go on to develop reactive airway disease / asthma

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 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.