Cytomegalovirus pulmonary infection
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Cytomegalovirus (CMV) pneumonia is a type of viral pneumonitis and occurs due to infection with cytomegalovirus (CMV), which is a member of the Herpetoviridae family.
CMV infection is particularly important in those who are immunocompromised (e.g. those with AIDS, allogeneic bone marrow transplantation recipient 3). In recipients of hematopoietic stem cell transplantations, the incidence of CMV can be around 20-35% 8.
A major biological characteristic of CMV (as with other herpes viruses) is its ability to become latent in the human host and therefore the potential for reactivation.
Findings on chest radiographs are usually non-specific.
CT findings are non-specific and diverse and have been described without distinction between AIDS and non-AIDS patients. Commonly described findings include:
- mixed alveolar-interstitial infiltrative opacification
ground-glass opacities 1
- relatively common feature, may be seen in ~67% of cases 5
- ground-glass opacities 1
- small pulmonary nodules 4,7
- nodules tend to have bilateral symmetrical distribution and involve all zones 6
- confluent consolidation 1
- may be more marked towards the lower lobes 6
- bronchiectasis 1
- interstitial reticulation without air space opacification 1,4
Other described features include:
The imaging differential is broad but in the immunosuppressed population consider:
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- 6. Kang EY, Patz EF, Müller NL. Cytomegalovirus pneumonia in transplant patients: CT findings. J Comput Assist Tomogr. 1996;20 (2): 295-9. Pubmed citation
- 7. Gasparetto EL, Ono SE, Escuissato D et-al. Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings. Br J Radiol. 2004;77 (921): 724-7. Pubmed citation
- 8. Vogel MN, Brodoefel H, Hierl T et-al. Differences and similarities of cytomegalovirus and pneumocystis pneumonia in HIV-negative immunocompromised patients thin section CT morphology in the early phase of the disease. Br J Radiol. 2007;80 (955): 516-23. doi:10.1259/bjr/39696316 - Pubmed citation