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Adenovirus Pneumonia in Adults: Radiographic and High-Resolution CT Findings in Five Patients

Semin Chong1, Kyung Soo Lee1, Tae Sung Kim1, Myung Jin Chung1, Man Pyo Chung2 and Joungho Han3

1 Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50, Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea.
2 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
3 Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.


Figure 1
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  		Fig. 1A —35-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. Anteroposterior chest radiograph shows patchy opacities (arrows) in both lungs. Also note endotracheal intubation tube and central venous line.

 

Figure 2
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  		Fig. 1B —35-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. High-resolution (1.0-mm collimation) CT scans obtained at level of great vessels (B) and right inferior pulmonary vein (C) show extensive and patchy ground-glass opacities (arrows) associated with interlobular septal thickening (arrowheads) and intralobular linear opacities in both upper lobes, forming so-called crazy paving appearance. Also note small amount of left pleural effusion.

 

Figure 3
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  		Fig. 1C —35-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. High-resolution (1.0-mm collimation) CT scans obtained at level of great vessels (B) and right inferior pulmonary vein (C) show extensive and patchy ground-glass opacities (arrows) associated with interlobular septal thickening (arrowheads) and intralobular linear opacities in both upper lobes, forming so-called crazy paving appearance. Also note small amount of left pleural effusion.

 

Figure 4
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  		Fig. 1D —35-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. Photomicrograph of pathologic specimen obtained by videotape-assisted thoracoscopic surgery biopsy shows intraalveolar fibrinous exudate forming hyaline membrane (arrows) and interstitial fibroblastic proliferation (arrowheads), suggestive of mixed exudative and proliferative phase of diffuse alveolar damage. (H and E, x100)

 

Figure 5
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  		Fig. 1E —35-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. Photomicrograph of pathologic specimen shows alveolar lining cell with intranuclear inclusions, which are surrounded by halo (arrows). (H and E, x1,000)

 

Figure 6
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  		Fig. 1F —35-year-old woman with non-Hodgkin's lymphoma who developed adenovirus pneumonia 1 year after allogeneic peripheral blood stem cell transplantation. Photomicrograph of pathologic specimen after immunohistochemical staining for adenovirus shows poorly demarcated smudges (arrowheads) within nucleus, indicating positivity for adenovirus infection. (x400)

 

Figure 7
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  		Fig. 2A —76-year-old woman with history of fever and dyspnea who developed adenovirus pneumonia. Chest radiograph shows patchy areas of parenchymal opacities (arrows) in both lungs.

 

Figure 8
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  		Fig. 2B —76-year-old woman with history of fever and dyspnea who developed adenovirus pneumonia. High-resolution (1.0-mm collimation) CT scans obtained at subcarinal level (B) and at level of left basal trunk (C) show patchy subpleural ground-glass opacities (arrows) in both lungs, associated with consolidative areas (arrowheads).

 

Figure 9
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  		Fig. 2C —76-year-old woman with history of fever and dyspnea who developed adenovirus pneumonia. High-resolution (1.0-mm collimation) CT scans obtained at subcarinal level (B) and at level of left basal trunk (C) show patchy subpleural ground-glass opacities (arrows) in both lungs, associated with consolidative areas (arrowheads).

 

Figure 10
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  		Fig. 3A —36-year-old woman with acute myelogenous leukemia who developed adenovirus pneumonia 4 months after allogeneic bone marrow transplantation. A, High-resolution (1.0-mm collimation) CT scan obtained at level of great vessels in thoracic inlet shows subpleural consolidation (arrow) in right upper lobe and patchy ground-glass opacities (arrowheads) in both lungs.

 

Figure 11
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  		Fig. 3B —36-year-old woman with acute myelogenous leukemia who developed adenovirus pneumonia 4 months after allogeneic bone marrow transplantation. B, CT scan obtained at level of aortic arch shows patchy ground-glass opacities (arrowheads) with random distribution in both lungs.

 

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