CTICasesChlamydia pneumoniae Airway-Centered Pneumonia
Imaging findings
A 70-year-old with respiratory symptoms and many negative COVID PCRs has extensive centrilobular and discrete tree-in-bud nodules with bilateral, patchy, asymmetric bronchial wall thickening indicating an airway-centered infection, plus areas of organizing pneumonia with atoll (reverse halo) and fairy-ring configurations. Testing was positive for Chlamydia pneumoniae.
Key takeaways
Chlamydia pneumoniae can cause an airway-centered infection with tree-in-bud nodularity, bronchial wall thickening, and organizing pneumonia. The nodular fairy-ring variant of the reverse halo sign (irregular, nodular rings, as opposed to the cleaner bands seen in COVID or non-infectious organizing pneumonia) favors an infectious, often granulomatous, cause and probably reflects organizing pneumonia around airways already bearing centrilobular nodules.
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