Which of the following findings is most commonly expected in a pediatric patient with viral pneumonia?

• A. Positive blood cultures for Streptococcus pneumoniae
• B. Lobar consolidation with air bronchograms
• C. Elevated neutrophil count with left shift
• D. Diffuse interstitial infiltrates on chest X-ray

Answer: (D)

Verified step by step guidance

1. Understand the typical clinical and radiological features of viral pneumonia in pediatric patients. Viral pneumonia often affects the lung interstitium rather than the alveoli directly.
2. Recognize that bacterial pneumonia, such as that caused by Streptococcus pneumoniae, is more likely to present with positive blood cultures and lobar consolidation on chest X-ray, which are less common in viral pneumonia.
3. Recall that bacterial infections typically cause an elevated neutrophil count with a left shift (increase in immature neutrophils), whereas viral infections often show a normal or slightly elevated lymphocyte count instead.
4. Focus on the chest X-ray findings: viral pneumonia usually presents with diffuse interstitial infiltrates, which appear as widespread, fine, reticular or patchy opacities throughout the lung fields, rather than localized lobar consolidation.
5. Summarize that the most common finding in pediatric viral pneumonia is diffuse interstitial infiltrates on chest X-ray, distinguishing it from bacterial pneumonia features such as lobar consolidation and neutrophilia.