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Chest Computed Tomographic Imaging Characteristics of Viral Acute Lower Respiratory Tract Illnesses: A Case-Control Study

Miller, Wallace T. Jr MD*; Barbosa, Eduardo Jr MD*; Mickus, Timothy J. MD; Mullin, Christopher MD; Van Deerlin, Vivanna M. MD, PhD§; Shiley, Kevin T. MD

Journal of Computer Assisted Tomography: July-August 2011 - Volume 35 - Issue 4 - p 524-530
doi: 10.1097/RCT.0b013e31821d6cd3
Thoracic Imaging

Objective: This study aimed to determine whether computed tomographic (CT) findings can distinguish viral lower respiratory tract illness (LRTI) from other conditions.

Methods: Three radiologists reviewed CT images of patients with LRTI who underwent testing for respiratory viral infection. Imaging findings in subjects with positive viral assays were compared with subjects with negative assays.

Results: Of 334 subjects, 93 were positive for viral LRTI. Tree-in-bud opacities and bronchial wall thickening were observed more often in subjects with viral LRTI (P < 0.05). Multifocal airspace disease occurred with similar frequency in both groups. Diffuse airspace opacification was negatively associated with viral LRTI. Pleural effusion was observed more often among subjects without viral LRTI (P < 0.001).

Conclusions: Airway inflammatory changes such as tree-in-bud opacities, bronchial wall thickening, and peribronchiolar consolidation are associated with community-acquired viral LRTI. Recognition of these findings should prompt testing for viral infection. Multifocal consolidation is commonly found in cases of viral LRTI but is nonspecific.

From the *Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA; †Department of Radiology, Allegheny General Hospital, Pittsburg, PA; ‡Department of Medicine, Columbia University Medical Center, New York, NY; §Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA; and ∥Division of Infectious Diseases, Mercy Hospital of Buffalo, Buffalo, NY.

Received for publication November 24, 2010; accepted February 25, 2011.

Reprints: Wallace T. Miller Jr, MD, Department of Radiology, Silverstein 1, University of Pennsylvania School of Medicine, Philadelphia, PA, 19104 (e-mail:

The authors have no disclosures. The research was performed without external funding.

© 2011 Lippincott Williams & Wilkins, Inc.