Citation, DOI & article data
Varicella pneumonia is a type of viral pneumonia. It is a common cause of multiple small round calcific lung lesions. Varicella-zoster virus most commonly causes self-limited benign disease (chickenpox) in children. However, in adults it tends to cause significant complications including varicella pneumonia.
Varicella pneumonia is the most serious complication of disseminated varicella-zoster virus infection with mortality rates of 9-50%. More than 90% of cases of varicella-zoster virus pneumonia in adults occur in patients with lymphoma or compromised immune systems.
Histologic features of varicella-zoster virus pneumonia are those of diffuse alveolar damage. With recovery from the initial disease, spherical nodules are seen, scattered randomly throughout the lung parenchyma.
- multiple 5-10 mm ill-defined nodules that may be confluent and fleeting
- small, round nodules usually resolve within a week after the disappearance of the skin lesions but may persist for months
- lesions can calcify and can persist as numerous, well-defined, randomly scattered, 2-3 mm dense calcifications
- well-defined and ill-defined nodules diffusely throughout both lungs
- nodules with a surrounding halo of ground-glass opacity, patchy ground-glass opacity, and coalescence of nodules are also seen
The differential diagnosis of very dense miliary opacities includes:
- healed varicella pneumonia
- pulmonary hemosiderosis, e.g. mitral stenosis
- repeated hemorrhage, e.g. Goodpasture syndrome
- silicosis: exposure to pure silica
- pulmonary alveolar microlithiasis
- calcified metastases, e.g. osteosarcoma
- 1. Kim JS, Ryu CW, Lee SI et-al. High-resolution CT findings of varicella-zoster pneumonia. AJR Am J Roentgenol. 1999;172 (1): 113-6. doi:10.2214/ajr.172.1.9888749 - Pubmed citation
- 2. Maher TM, Gupta NK, Burke MM et-al. CT findings of varicella pneumonia after lung transplantation. AJR Am J Roentgenol. 2007;188 (6): W557-9. doi:10.2214/AJR.05.0850 - Pubmed citation
- 3. Eskenazi AE, Campbell AB. Radiological case of the month. Varicella mimicking pulmonary metastasis in a patient with rhabdomyosarcoma. Arch Pediatr Adolesc Med. 1997;151 (10): 1051-2. Pubmed citation