Herpes simplex virus 1 pneumonia: conventional chest radiograph pattern

The aim of this study was to describe the findings on plain chest radiograp hs in patients with herpes simplex virus pneumonia (HSVP). The study was ba sed on 17 patients who at a retrospective search have been found to have a monoinfection with herpes simplex virus. The diagnosis was established by i solation of the virus from material obtained during fiberoptic bronchoscopy (FOB) which also included broncho-alveolar lavage and tissue sampling. Fou rteen patients had a chest radiograph performed within 24 h of the date of the FOE. Two radiographs showed no abnormalities of the lung parenchyma. Th e radiographs of the other 12 patients showed lung opacification, predomina ntly lobar or more extensive and always bilateral. Most patients presented with a mixed airspace and interstitial pattern of opacities, but 11 of 14 s howed at least an airspace consolidation. Lobar, segmental, or subsegmental atelectasis was present in 7 patients, and unilateral or bilateral pleural effusion in 8 patients, but only in 1 patient was it a large amount. In co ntradiction to the literature which reports a high correlation between HSVP and acute respiratory distress syndrome (ARDS), 11 of 14 patients did not meet the pathophysiological criteria for ARDS. The radiologist may suggest the diagnosis of HSVP when bilateral airspace consolidation or mixed opacit ies appear in a susceptible group of patients who are not thought to have A RDS or pulmonary edema. The definite diagnosis of HSV pneumonia can be esta blished only on the basis of culture of material obtained by broncho-alveol ar lavage.