Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
J Thorac Imaging. 2018 Nov;33(6):384-389. doi: 10.1097/RTI.0000000000000364.
The aim of this study was to evaluate CT features of pneumonias caused by the alpha Herpesviruses, herpes simplex virus (HSV), and varicella-zoster virus (VZV).
By searching the electronic medical record from 2005 to 2017, we identified 12 patients with HSV and 15 with VZV pneumonia. Four patients with coinfection were excluded from imaging analysis. Two radiologists reviewed computed tomography scans (CTs) for findings including ground glass and nodules. CTs were assigned to a predominant pattern of crazy paving, nodular, or other.
The most common risk factor was hematologic malignancy, present in 58% of HSV and 47% of VZV patients. Crazy paving was seen in 50% of HSV and 31% of VZV cases; a nodular pattern was present in 20% of HSV and 69% of VZV patients (P=0.03).
Most patients with alpha Herpesvirus pneumonias demonstrated either a crazy paving or nodular pattern on CT. The nodular pattern was significantly more common in VZV than in HSV. Radiologists should consider these rare infections when evaluating immunocompromised patients with these imaging patterns.
本研究旨在评估由α疱疹病毒（单纯疱疹病毒[HSV]和水痘-带状疱疹病毒[VZV]）引起的肺炎的 CT 特征。
通过检索 2005 年至 2017 年的电子病历，我们确定了 12 例 HSV 肺炎和 15 例 VZV 肺炎患者。从影像学分析中排除了 4 例合并感染的患者。两名放射科医生对包括磨玻璃影和结节在内的 CT 表现进行了回顾性分析。将 CT 分为鹅卵石样、结节样或其他主要表现模式。
最常见的危险因素是血液系统恶性肿瘤，HSV 组和 VZV 组分别占 58%和 47%。HSV 组中 50%的患者出现鹅卵石样表现，而 VZV 组中 31%的患者出现该表现；HSV 组中 20%的患者出现结节样表现，而 VZV 组中 69%的患者出现该表现（P=0.03）。
大多数α疱疹病毒肺炎患者的 CT 表现为鹅卵石样或结节样。与 HSV 相比，VZV 更常见结节样表现。当评估具有这些影像学表现的免疫功能低下患者时，放射科医生应考虑这些罕见的感染。
