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Weekly Chest CasesArchive of Old Cases

Case No : 1191 Date 2020-08-17

  • Courtesy of Sung Ho Hwang, Yu-Whan Oh / Department of Radiology, Korea University Anam Hospital
  • Age/Sex 51 / M
  • Chief Complaintdyspnea (1 month)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pneumocystis pneumonia / Human immunodeficiency virus (+)
Radiologic Findings
Figure 1. Chest radiography shows interstitial shadows, hazy opacities, and consolidations in bilateral lung fields.
Figure 2-5. Transverse CT images of lung with lung window setting shows parenchymal distortion, patchy ground-glass opacities, and irregular cysts in bilateral lungs.

He was diagnosed HIV positive 5 years ago.
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. Pneumocystis pneumonia almost always have CD4 counts less than 200 cells/mm3. Affected patients present with an insidious onset of fever, dry cough, and dyspnea. The classic appearance of Pneumocystis pneumonia on chest radiography is bilateral perihilar or diffuse symmetric opacities, which may be finely granular, reticular, or ground-glass opacities in appearance. The classic CT finding in Pneumocystis pneumonia is extensive ground-glass opacity, which corresponds to the presence of intra-alveolar exudate, consisting of surfactant, fibrin, cellular debris, and organisms. When a tree-in-bud appearance is present on CT, Pneumocystis pneumonia infection is unlikely. Cystic lesions are found in approximately 50% of patients. Residual interstitial fibrosis after Pneumocystis pneumonia also is common.
Please refer to
Case 97, Case 118, Case 217, Case 267, Case 390, Case 727, Case 797, Case 823, Case 942, Case 948, Case 994, Case 1137,
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 Müller, A Soares Souza Jr, et al.: Pulmonary disease in patients with AIDS: high-resolution CT and pathologic findings. AJR Am J Roentgenol. 2005; 184:757-764
Keywords
lung, fungal infection, pneumocystis pneumoniain , AIDS,

No. of Applicants : 68

▶ Correct Answer : 12/68,  17.6%
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - Mayo Clinic , Japan HIROAKI TAKAHASHI
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Private sector , Greece VASILIOS TZILAS
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 20/68,  29.4%
  • - The University of Kyoto Hospital , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - CH de la Cote Basque , France PAUL ARDILOUZE
  • - McGill University Health Center , Canada Alexandre Semionov
  • - NIMS, HYDERABAD , India BHASKAR K
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Suita Tokushukai Hospital , Japan JUNKO OCHI
  • - GEMS, Srikakulam, Andhra Pradesh , India RAMU C
  • - TB centre kasaragod. , India rikhy krishnan
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
  • - , Japan KAZUMA TERAUCHI
▶ Semi-Correct Answer : 2/68,  2.9%
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Other , Korea (South) MINSU KIM
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