Chest X-ray findings indicative of viral pneumonia?

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Viral pneumonia classically causes inflammation in the lung interstitium and small airways, leading to a diffuse, bilateral interstitial pattern on chest radiographs. This appears as widespread interstitial markings and sometimes peribronchial thickening, often with mild hyperinflation or subtle subsegmental atelectasis. Such a bilateral interstitial infiltrate fits a viral or atypical infectious process, rather than isolated alveolar filling.

In contrast, lobar consolidation represents dense, focal airspace opacification from alveolar exudate, a pattern more typical of bacterial pneumonia and usually localized to one region. Pleural effusion can accompany infections but is not specific to viral disease. Cavitation implies necrotizing infection or other chronic processes (like TB or certain bacteria), not a straightforward viral pneumonia.

Thus, bilateral interstitial infiltrates on a chest X-ray are most consistent with viral pneumonia.