A diffuse distribution was defined as bilateral abnormality that involves an equivalent volume of the two lungs. If there were two or more foci, the distribution of abnormality was considered multifocal and subclassified as either unilateral or bilateral. A focal distribution was defined as a single focus of abnormality. The distribution of abnormalities was categorised as focal, multifocal or diffuse.
Chest radiograph findings were classified as interstitial lung disease (reticulation, linear or peribronchial interstitial shadowing), bilateral patchy areas of consolidation, lobar consolidation, or diffuse areas of air space consolidation. Two radiologists unaware of the laboratory findings reviewed the images independently and reached a diagnostic conclusion by consensus. The symptoms typically occurred at 3–8 days before the chest radiographs. The chest radiographs were taken using either digital or computed radiography, via an anteroposterior projection with the child lying. Other blood tests indicative of pneumonia of bacterial origin, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), were also performed. In addition, blood specimens were obtained within 24 h of admission for bacterial cultures the results were negative within the study population. Chest radiographs were performed in all patients. Respiratory specimens were tested using direct immunofluorescence assays for influenza B, adenovirus, RSV, PIFV-1, -2 and -3, or using quantitative real-time polymerase chain reaction (Q-PCR) for influenza A (Subtype H1N1). Nasopharyngeal swab specimens were routinely collected within 24 h of admission, and bronchial aspirate samples were obtained after tracheal intubation. The medical charts, radiographs and laboratory findings were retrospectively reviewed for patients under 15 years old hospitalised with acute respiratory illness between December 2009 and June 2010 (2715 cases). This study was approved by the institutional review board of our hospital. The aim of the current study was to compare the chest radiographic representations among various types of viral pneumonia, to identify radiographic diagnostic indicators that may predispose to viral pneumonia and to assess whether any particular abnormal radiographic findings are associated with certain specific viral pathogens. To our knowledge, reports on chest radiological findings in paediatric viral pneumonia are scarce. When used in conjunction with clinical presentations and laboratory tests, radiological findings could provide useful information for differential diagnosis, management and response prediction in patients with viral pneumonia. Chest radiograph is usually the first imaging modality prescribed in the assessment of acute respiratory symptoms.
Imaging examination plays a crucial role in the detection and management of patients with pneumonia. Influenza viruses A and B, adenovirus, respiratory syncytial virus (RSV) and parainfluenza viruses Types 1, 2 and 3 (PIFV-1, PIFV-2, PIFV-3) are among the most common viruses that cause pneumonia in children.
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