CTICasesRSV Bronchiolitis and Bronchitis Post-Stem Cell Transplant
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Imaging findings
Chest radiograph showed tram tracks and tubular opacities, consistent with airway wall pathology. High-resolution CT demonstrated diffuse bronchial and bronchiolar wall thickening. A hallmark finding was the presence of small branching tubular opacities, approximately 1-2 mm in diameter, representing lobular bronchiolar pathology (sometimes described as tree-in-bud). A follow-up CT also showed patchy consolidation in the upper lungs, suggesting possible pneumonitis in addition to the airway disease.
Key takeaways
Respiratory Syncytial Virus (RSV) infection in immunocompromised patients, such as stem cell transplant recipients, can cause severe bronchitis and bronchiolitis. Imaging findings on CT include conspicuous bronchial and bronchiolar wall thickening and the characteristic branching tubular opacities (tree-in-bud pattern) indicating inflammation and mucous plugging of the small airways. Concomitant pneumonitis can also be present.
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