Learning objectives
1. Define – Differentiate PJP in AIDS patients
2. Identify HRCT findings in PJP
Background
Pulmonary infections in HIV/AIDS patients,
constitute a major cause of morbidity and mortality.
Pneumocystis jiroveciipneumonia (PJP)is the most common opportunistic,
life- threatening,
pulmonary infection in HIV/AIDS population.
Patients with <200 cells/mm are more susceptible to this infection. Pneumocystis jirovecii is a unicellular organism classified as a atypical fungus but behaves as a protozoan and is composed of small cysts which produce intracystic sporozoites.
Clinical findings are often subtle and non- specific,
the most common of which are dyspnea and non-productive cough.
Diagnosis is based on...
Findings and procedure details
Typical findings:
1. Ground glass opacification in the perihilar and mid zones with in some cases (40%) sparing of peripheral subpleural lung - principal finding. In patients receiving prophylactic aerosolized medication,
the upper lobes are frequently involved whereas in patients who are not under such prophylaxis the lower lobes are more prone to infection.
2. Areas-foci of consolidation scattered through the lung parenchyma.
3. Septal thickening-reticular opacities.
Septal thickening which in combination with the ground glass pattern can lead to crazy paving appearance.
4. Pneumatoceles...
Conclusion
1. Presentation of PJP is usually non-specific and insidious,
thus in patients with AIDS,
a high index of suspicion is required because the radiologist is often the first to propose the diagnosis of PJP.
2. HRCT is more sensitive in evaluating patients with suspected PCP when there is clinical suspicion but normal or inconclusive chest radiographs.
Personal information
Dr Vasiliki Mellou
Radiology Department,
“Evangelismos” General Hospital of Athens - Athens/GR
email:
[email protected]
References
Kanne JP,
Yandow DR,
Meyer CA.
Pneumocystis jiroveci Pneumonia: High-Resolution CT Findings in Patients With and Without HIV Infection,
American Journal of Roentgenology.
2012;198: W555-W561 Read More: http://www.ajronline.org/doi/full/10.2214/AJR.11.7329 doi10.2214/AJR.11.7329 - Pubmed citation
Maffessanti M,
Polverosi R,
Dalpiaz G et-al.
Diffuse lung diseases,
clinical features,
pathology,
HRCT.
Springer Verlag.
(2006) ISBN:8847004292.
Read it at Google Books - Find it at Amazon
Hartman TE,
Primack SL,
Müller NL et-al.
Diagnosis of thoracic complications in AIDS: accuracy of CT.
AJR Am J Roentgenol.
1994;162 (3): 547-53.
AJR Am...