대한흉부영상의학회 Weekly Chest Cases

Case No : 1137 Date 2019-08-12

Courtesy of Sung Ho Hwang, Yu-Whan Oh / Korea University Anam Hospital
Age/Sex 27 / F
Chief Complaintcough and fever for 1 week

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Diagnosis With Brief Discussion

Diagnosis: Pneumocystis pneumonia in a HIV(+) patient
Radiologic Findings: Chest radiograph shows bilateral symmetric lung opacities (Fig. 1). Transverse images of high-resolution computed tomography (HRCT) (Fig. 2-5) show multiple centrilobular nodules and ground-glass opacities, located predominantly in bilateral lung bases.
Brief Review: Pneumocystis is an opportunistic fungal pulmonary pathogen; the pathogenic form in humans is named Pneumocystis jirovecii. Pneumocystis pneumonia remains one of the most common AIDS-defining opportunistic infections, with pneumocystis patients almost always having CD4 counts less than 200 cells/mm3. Outward symptoms most often consist of an insidious onset of fever, dry cough, and dyspnea. The classic appearance of Pneumocystis pneumonia in chest radiographs is bilateral perihilar or diffuse symmetric opacities, which may be finely granular, reticular, or ground-glass in appearance. The classic CT finding in Pneumocystis pneumonia cases is extensive ground-glass opacity, which is attributable to the presence of intraalveolar exudate consisting of surfactant, fibrin, cellular debris, and organisms. However, when a tree-in-bud appearance is present on CT, Pneumocystis pneumonia infection is unlikely. Cystic lesions are also found in approximately 50% of patients, while residual interstitial fibrosis after Pneumocystis pneumonia is also common.
Please refer to: KSTR Imaging Conference 2006 Summer Case 6 ,
KSTR Imaging Conference 2004 Summer Case 8 ,
KSTR Imaging conference 2010 Summer Case 4 ,
KSTR Imaging Conference 2013 Spring Case 5 ,
KSTR Imaging Conference 2016 Spring Case 17 ,
KSTR Imaging Conference 2015 Spring Case 6,
References: 1. C Mayuad, A Parrot, J Cadranel: Pyogenic bacterial lower respiratory tract infection in human immunodeficiency virus-infected patients. Eur Respir J. 2002;20 (suppl):28-39
2. E Marchiori, NL M
Keywords: lung, fungal infection,

No. of Applicants : 67

▶ Correct Answer : 7/67, 10.4%

- Mayo Clinic , United States AKITOSHI INOUE
- McGill University Health Center , Canada Alexandre Semionov
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- Fujieda Municipal General Hospital , Japan HAYATO NOZAWA
- University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
- Kyeongpook National University Hospital , Korea (South) MIRAN KIM
- Yeungnam University Medical Center , Korea (South) YOUNG WOO SIM

▶ Correct Answer as Differential Diagnosis : 17/67, 25.4%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Ondokuz Mayis University , Turkey CETIN CELENK
- , Korea (South) CHOHEE KIM
- Seoul National University Hospital , Korea (South) Ju Gang Nam
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- The University of Tokyo Hospital , Japan RYO KUROKAWA
- Dae Jin Medical Center , Korea (South) JIYOUNG CHOI
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Chonbuk National University Hospital , Korea (South) KUM JU CHAE
- , Korea (South) JANG SEONG WON
- TB centre kasaragod. , India rikhy krishnan
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Toranomon Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Private sector , Greece VASILIOS TZILAS
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Semi-Correct Answer : 2/67, 3.0%

- Diagnose.me (BV) / Royal Perth Hospital , Australia YURANGA WEERAKKODY
- Ajou University Hospital , Korea (South) YOO YOUNGJIN

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1137 Date 2019-08-12

Discussion

No. of Applicants : 67