대한흉부영상의학회 Weekly Chest Cases

Case No : 217 Date 2001-12-22

Courtesy of Jung Im Jung, MD / St. Mary's Hospital, Catholic University, Seoul, Korea
Age/Sex 27 / F
Chief ComplaintDyspnea, History of allogenic BMT for AML 181 days ago

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Diagnosis With Brief Discussion

Diagnosis: Pneumocystis Carinii Pneumonia
Radiologic Findings: Chest PA shows diffuse ground glass opacity in both middle and lower lung fields. HRCT shows diffuse ground glass opacities in both lungs. Small patchy consolidation and interlobular septal thickenings are associated in both lower lobes.
Brief Review: Pneumocystis carinii pneumonia is seen much less frequently in BMT recipients since the introduction of routine prophylaxis. It is seen mainly in those patients who are unable to tolerate the prophylaxis. Usually PCP occurs 1 months-6 months after BMT (median time of PCP is 2 months). Histologically, there may be intra-alveolar histiocytes or a mixed inflammatory infiltrate with or without associated hemorrhage.
The classic initial radiographic manifestation is that of a central and bilateral periphilar process that progressed over 3 to 5 days to a homogenous diffuse alveolar consolidation. The pattern may be mistaken for pulmonary edema, but the heart size is usually normal. Hilar adenopathy and pleural effusion are distinctly unusual. One important characteristic is the sparing of previously radiated lung. The most characteristic finding at HRCT is ground-glass attenuation, that is, homogeneous increase in attenuation without obscuration of underlying pulmonary vessels. There is often a mosaic or geographic pattern with relatively normal secondary pulmonary lobules adjacent to diseased ones. The distribution may be diffuse, perihilar, or upper lobe. Other CT features include a miliary pattern, small nodules, focal masses, interstitial disease with reticulation, septal thickening and small cystic lesions.
References: 1. Soubani AO, Miller KB, Hassoun PM. Pulmonary complications of bone marrow transplantation. Chest 1996; 109: 1066-1077
2. Brown MJ, Miller RR, Muller NL. Acute lung diseases in the immunocompromised host: CT and pathologic examination findings. Radiology 1994; 190: 247-254
3. Winer-Muram HT, Gurney JW, Bozeman PM, Krance RA. Pulmonary complications after bone marrow transplantation. Radio Clin North Am 1996; 24 (1): 97-118
Keywords: Lung, Infection, Fungal infection, immune related, Pneumocystis Carinii Pneumonia

No. of Applicants : 18

▶ Correct Answer : 10/18, 55.6%

- Ansung Public Health Center, Korea Joon Woo Lee
- CHU Nancy-Brabois, France Denis Regent
- Gochang Hospital, Korea Jiyong Rhee
- Gospel Hospital Kosin University, Korea Kyung Hwa Jung
- Harasanshin hospital, Fukuoka, Japan Shunya Sunami
- Konkuk University Choongju Hospital, Korea Chang Hee Lee
- MH[CTC] PUNE, INDIA Vivek Sharma
- Pusan Paik Hospital, Korea Ki Bok Choi
- Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
- Sungji Hospital, Korea Jung Hee Kim

▶ Semi-Correct Answer : 8/18, 44.4%

- Chungang University Hospital, Korea Seung Hoon Ryu
- Daejeon Sun Hospital, Korea Dong Jip Na
- Gospel Hospital Kosin University Hyun Chul Kim
- Hanyang University Hospital, Korea Il Soo Jang
- Korea Cancer Center Hospital, Korea Donghee Park
- Ospedale di Fabriano, Italy Giancarlo Passarini
- Pulmonary Medicine Doctor, Korea Jae-Joon Yim
- Seoul National University Hospital, Korea Tae Jung Kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 217 Date 2001-12-22

Discussion

No. of Applicants : 18