Its RSV season again!

January 24, 2013

Chest XR, Non-Trauma, Respiratory, XR


Don’t you love working Jan and Feb in the Peds ED?  Or as I like to refer to it as the Mucus ED.

What findings on Chest Xray are consistent with viral pneumonia?

Viral CXR 2Viral CXR

Viral respiratory infections commonly cause an “interstitial” pattern on Chest XR.   Interstitial patterns can also be found in atypical bacterial pneumonia from organisms such as Bordatella pertussis, Chlamydia pneumonia, and Mycoplasma.  Findings include peribronchial cuffing, perihilar infiltrates or “haze”.  Peribronchial cuffing can be seen on the XR above:

PB Cuffing

Other findings in interstitial patterns can include fluid in fissures, bands of atelectasis.

Bronchioles are usually very difficult, if not impossible to identify in cross-section on a Chest XR.  They look like a small clear circle with a thin wall.  However, when they are inflammed and have surrounding edema peribronchial cuffing occurs.  Basically you see a dense fluid around an air-filled bronchiole.  This can be seen in asthma, viral illnesses, heart failure, pertussis, and other pathology (1).  Here is a link to a good web image of peribronchial cuffing close up and on crossection:

http://www.torontonotes.ca/interstitial-disease/peribronchial-cuffing

It is important to note that the Chest XR can support your diagnosis of viral respiratory infection but it is not 100%.  Keep in mind the atypical organisms and prescribe antibiotics if highly suspicious.  Prescribing antibiotics in respiratory infections is a controversial topic with many different thoughts and practice patterns.  I’m not going to poke that sleeping bear…

Author:  Russell Jones, MD

References

1.  Broder JS.  Diagnostic Imaging for the Emergency Physician.  Elsevier 2011.  Pg. 241.

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EMREMS: Radiology in Emergency Medicine

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