Pediatric Viral 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: Asthma, congenital heart disease
  • Complications: Small percentage get concurrent bacterial pneumonioa superinfection
  • Treatment: Antivirals in some cases
  • Clinical:

Radiology Cases of Viral Pneumonia

CXR of respiratory syncytial virus pneumonia
CXR PA and lateral shows airway thickening and lung hyperexpansion with flattening of the hemidiaphragms.

Radiology Cases of Viral 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.

Radiology Cases of Viral Pneumonia Causing Thymus Involution and Thymus Rebound

CXR of thymus rebound
CXR AP (left) shows central airway thickening and lung hyperexpansion. The thymus is not visible. Repeat CXR AP obtained 3 months after resolution of respiratory symptoms (right) shows normal central airways and lung expansion. The thymus is now well visualized and is normal in appearance.