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Weekly Chest CasesArchive of Old Cases

Case No : 118 Date 2000-01-29

  • Courtesy of Jung-Gi Im, MD, Jin Mo Goo, M.D. / Seoul National University Hospital, Seoul, Korea
  • Age/Sex 33 / M
  • Chief ComplaintDyspnea for three days He was known to be HIV-positive and a CD4 level was 50 cells/ mm3.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Cystic Pneumocystis carinii pneumonia (PCP)
Radiologic Findings
Chest radiograph shows hazy areas of increased lung density throughout the lungs.
Multiple thin-walled air-containing structures are identified in both upper lung zones.
HRCT scans show areas of ground glass attenuation, within which both thin-walled and thick-walled and cystic lesions are identified in both upper lobes.
Brief Review
Although PCP may occur at a CD4 level higher than 200 cells/mm3, and it remains a common AIDS-defining illness, the diagnosis should be more strongly considered in a patients with CD4 cells below this level,
and it is most common in patients with CD4 levels lower than 100 cells /mm3.

Patients typically present with insidious symptoms of fever, nonproductive cough, and dyspnea.

Thin-walled cystic lesions are recognized in about 10-34% of cases radiographically (1, 2), but they are more commonly identified with CT.
The pneumatoceles were typically thin-walled with no intracystic material
and no predilection for a particular area of the lung.
They were present on the initial radiograph or developed during treatment of PCP.
Cysts related to PCP are usually multiple, occur most often in the upper parts of the lungs,
and tend to decrease in size or resolve after the acute stage of the infection (2).
Cysts are responsible for the well-known propensity of these patients to develop spontaneous pneumothoraces (3).
References
1. Sandhu JS, Goodman PC. Pulmonary cysts associated with Pneumocystis carinii pneumonia in patients with AIDS. Radiology 1989;173:33-35
2. Chow C, Templeton PA, White CS. Lung cysts associated with Pneumocystis carinii pneumonia: radiographic characteristics, natural history, and complications. AJR 1993;161:527-531
3. Feurestein IM, Archer A, Pluda JM, Francis PS, Falloon J, Masur H, Pass HI, Travis WD. Thin-walled cavities, cysts, and pneumothorax in Pneumocystis carinii pneumonia: further observations with histopathologic correlation. Radiology 1990;174:697-702
Keywords
Lung, Infection, Fungal infection,

No. of Applicants : 60

▶ Correct Answer : 51/60,  85.0%
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  • - Gachon Medical School Gil Medical Center Seo Joon Beom
  • - Hospital de Leon. Leon. Spain Inmaculada Herraez Ortega
  • - Hospital General Universitario de Alicante Spain Juan Arenas
  • - Korea University Medical Center Jung-Ah Choi
  • - Pol. S.Orsola-Malpighi. University of Bologna, Italy Maurizio Zompatori
  • - Pusan National University Hospital Kun-Il Kim
  • - Samsung Medical Center Kyung Soo Lee
  • - Seoul National University Hospital Seong Ho Park
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
▶ Semi-Correct Answer : 3/60,  5.0%
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