대한흉부영상의학회 Weekly Chest Cases

Case No : 942 Date 2015-11-16

Courtesy of Jae Yeon Wi / Chung-ang university hospital
Age/Sex 47 / M
Chief ComplaintWeight loss (6kg / 1year), abnormalities detected on chest radiograph

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Diagnosis With Brief Discussion

Diagnosis: Pneumocystis pneumonia (Pneumocystis Jirovecii infection)
Radiologic Findings: Posteroanterior chest radiograph shows bilateral consolidation with cystic change in middle lung zones.
Chest CT images demonstrate multiple cysts with surrounding ground glass opacities in both lungs, especially central zone.
The patient’s blood test result was positive for HIV. Sputum PCR for Pneumocystis jirovecii organisms was positive.
Brief Review: Pneumocystis jirovecii is an atypical fungus that causes pneumonia in immunocompromised human hosts particulary those with deficiency in cell-mediated immunity. On HRCT, extensive ground-glass opacity is the principal finding in PJP, reflecting accumulation of intra-alveolar fibrin, debris, and organisms. A predilection for the upper lobes has also been described. Pulmonary cysts with varying shape, size and wall thickness occur in as many as one third of patients with PJP. The incidence of pulmonary cysts has been reported to be lower in patients without HIV infection than in HIV-infected patients Although spontaneous pneumothorax can occur in the absence of definable lung cysts, the frequency of spontaneous pneumothorax increases with when definable lung cysts present. Cysts may resolve after treatment and clearing of infection
Please refer to
References: Jeffrey P. Kanne, Donald R. Yandow, Cristopher A. Meyer. Pneumocystis jiroveci Pneumonia: High-Resolution CT Findings in Patients With and Without HIV Infection, AJR 2012; 198:W555–W561
Keywords: Lung, Infection, Fungal infection, PCP,

No. of Applicants : 93

▶ Correct Answer : 23/93, 24.7%

- Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
- All India Institute of Medical Sciences , India Ashish Gupta
- Kyoto University , Japan Akihiko Sakata
- DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
- Oita University, Faculty of Medicine , Japan Fumito Okada
- GHICL , France manuel toledano
- University of British Columbia , Canada Amr Ajlan
- �stanbul , Turkey Ayhan Yilmaz
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Chonnam national university hospital , Korea (South) INSOO JANG
- CNUH , Korea (South) 源
- NEPEAN HOSPITAL , Australia YOGESH THAKKAR
- Kizawa Memorial Hospital , Japan Yo Kaneko
- IRSA La Rochelle , France Denis Chabassiere
- Onomichi municipal hospital , Japan Hirofumi Mifune
- NASA SCANS , India RAKESH BHATIA
- Fortis hospital , Mohali , India Shaleen Rana
- CLCC Rennes , France nicolas gautier
- Gifu Central Hospital , Japan Haruo Watanabe
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Santosh hospital,Bengaluru , India Pravin Mahadevappa
- Medicheck health care , Korea (South) Chae Lim

▶ Correct Answer as Differential Diagnosis : 9/93, 9.7%

- SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OOKUBO
- KG hospital & PG Institute , India SANAL KUMAR
- Ondokuz Mayis University , Turkey Cetin Celenk
- KEM ,MUMBAI,INDIA , India SHAH ALAM
- Ajou University Hospital , Korea (South) Young Keun Sur
- , Korea (South)
- Wuhan Union Hospital , China Qiguang Cheng
- ZIGONG TCM HOSPITAL OF CHINA , China Cao CunyouFF
- chp st martin , France Mariotte benoit

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 942 Date 2015-11-16

Discussion

No. of Applicants : 93