title: Herpes-Simplex-Virus 1 pneumonia in the immunocompromised host: high-resolution CT patterns in correlation to outcome and follow-up.
abstract: OBJECTIVE
  To identify the high-resolution CT (HRCT) patterns of Herpes-Simplex-Virus 1 (HSV) pneumonia in immunocompromised patients and correlate findings to outcome and radiographic follow-up until death or complete resolution of findings.
  
  
  METHODS
  HRCT data-sets and plain radiographic follow-ups were reviewed in 25 immunocompromised patients with confirmation of new onset HSV-1 pneumonia. Pattern and distribution of abnormalities was assessed by two chest radiologists and findings evaluated regarding outcome and dynamics.
  
  
  RESULTS
  The most frequent CT abnormalities included ground-glass attenuation (n=18; 72%) in a bilateral, symmetric and random distribution, air-space consolidations (n=13; 52%) in a bilateral, asymmetric and peribronchial allocation and interlobular septal thickening (n=6; 24%). When classified by leading HRCT pattern, patients subdivided into distinct groups with either dominant ground-glass attenuation or air-space consolidation. Six patients died after a median 8 days of diagnosis; the median interval until complete radiographic remission of pathology was 20 days. Pre-dominance of air-space consolidations was associated with significant delay of improvement (p=0.023); however, patient outcome was comparable in both subgroups (p=0.9).
  
  
  CONCLUSIONS
  Diagnosis of HSV pneumonia is challenging and requires familiarity with two distinct HRCT patterns: predominance of ground-glass opacities or air-space consolidations. Whilst the two forms are not linked to patient outcome they demonstrate a variable dynamic at follow-up.
authors.affiliation: Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen, Germany. h.brodoefel@t-online.de
authors.forename: H
authors.initials: H
authors.lastname: Brodoefel
authors.forename: M
authors.initials: M
authors.lastname: Vogel
authors.forename: D
authors.initials: D
authors.lastname: Spira
authors.forename: C
authors.initials: C
authors.lastname: Faul
authors.forename: R
authors.initials: R
authors.lastname: Beck
authors.forename: C D
authors.initials: CD
authors.lastname: Claussen
authors.forename: M
authors.initials: M
authors.lastname: Horger
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006561:Herpes Simplex / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000276:immunology; D018259:Herpesvirus 1, Human / Q000276:immunology*; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D011024:Pneumonia, Viral / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000276:immunology*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013223:Statistics as Topic; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents