Cytomegalovirus pneumonia

Case contributed by Melbourne Uni Radiology Masters

Presentation

90 days post bone marrow transplant. Now swinging fevers.

Patient Data

Age: 20 years
Gender: Male

CT Chest

CT

Extensive patchy regions of groundglass density within both lungs most prominent within the right middle lobe and bilateral lower lobes. No cavitation or lobar collapse/consolidation. No tracheal or endobronchial lesions. No pleural effusion or pneumothorax.

No cardiomegaly or pericardial effusion. Within the limitation of the lack of cardiac gating, there is no evidence of aortic dissection.

No significant supraclavicular, axillary, mediastinal or hilar lymphadenopathy. Prominent bilateral lower lobe bronchopulmonary lymph nodes, likely reactive.

No destructive bony lesion.

Right central line in situ with tip within the superior right atrium.

Limited images of the upper abdomen are unremarkable.

Case Discussion

This case demonstrates acute extensive bilateral ground glass opacities in an immunocompromised patient, with differentials including Pneumocystis jirovecii and CMV, with the latter favored given the elevated CMV viral load. 

CMV PCR/LOAD
CMV DNA PCR          DETECTED                         
CMV LOAD(Copies/mL)  76                              
Log10 (Copies/mL)    1.88                          

Cytomegalovirus pneumonia is a type of viral pneumonitis and occurs due to infection with cytomegalovirus (CMV), which is a member of the Herpetoviridae family.

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
  • small pulmonary nodules 
    • nodules tend to have bilateral symmetrical distribution and involve all zones 
  • confluent consolidation 
    • may be more marked towards the lower lobes 
  • bronchiectasis 
  • interstitial reticulation: without air space opacification 

The imaging differential is broad but in the immunosuppressed population consider:

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