CTICasesViral Bronchopneumonia due to Human Metapneumovirus in an Immunosuppressed Patient
Imaging findings
In an immunosuppressed patient with multiple myeloma on chemotherapy presenting with acute respiratory illness, CT shows bronchial wall thickening with a heterogeneous, non-uniform distribution of bronchiolitis, scattered centrilobular nodules, and areas of tree-in-bud pattern; several days later, follow-up imaging shows progression to a more uniform pattern with numerous small airway-centered nodules.
Key takeaways
Viral panel testing was positive for human metapneumovirus, and the case is presented as a useful contrast to a more purely diffuse ground-glass/nodular hypersensitivity pattern, since this heterogeneous bronchitis and bronchiolitis pattern with tree-in-bud change and bronchial wall thickening is more typical of viral airway infection; basilar predominance of coarser findings can reflect aspirated secretions generated from upper-lung viral infection settling into the lower lobes.
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