Answer AIDS PNA…

October 22, 2013

Chest XR, Devices, Non-Trauma, Respiratory, XR


On a previous post I posed a question on the differential diagnosis of pneumonia in an AIDS patient with this chest Xray:

AIDS CXR PNA

This is a multilobar pneumonia vs. ARDS (Acute Respiratory Distress Syndrome).  AIDS patients can have the same bacterial causes of multilobar pneumonia that is present in other patient populations (Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus Influenza, Moraxella catarrhalis, Mycoplasma pneumoniae, Chlamydophila pneumoniae, Legionella pneumoniae, etc.).  If they are healthcare associated or hospital-acquired further drug-resistant bugs such as Pseudomonas aeruginosa and MRSA could be implicated.  Infectious organisms specifically involved in immunocompromised hosts could include (among others):

  • Pneumocystis Jiroveci (PCP pneumonia)
  • Coccidioides species
  • Cytomegalovirus (CMV)
  • Tuberculosis (TB)
  • Histoplasma species
  • Aspergillus species
  • Mycobacterium avium complex (MAC)
  • Influenza
  • Herpes simplex virus (HSV)
  • Varicella-zoster virus (VZV)
  • Legionella species
  • Nocardia species
  • Cryptococcus neoformans
  • Mucoraceae species
  • Strongyloides species
  • Toxoplasma species
  • Capnocytophaga species

Non-infectious causes of multilobar infiltrates such as this could include diffuse alveolar hemorrhage, cardiogenic pulmonary edema, ARDS, among others. The multilobar involvement of the Xray above could implicate certain pathogens in favor of others (for example, Pneumocystis Jiroveci is usually multilobar as opposed to Streptococcus pneumonia which usually will cause a dense, lobar pneumonia).  The other interesting feature of the Xray is that it appears multi-nodular.  This can implicate entities such as CMV rather than a bat-wing ground-glass appearance of Pneumocystis Jiroveci.  For further discussion on pneumonia radiographic findings in AIDS, please see radiopaedia.org discussion below:

http://radiopaedia.org/articles/pulmonary-manifestations-of-hiv-aids

Incidentally, the endotracheal tube should be pulled back about 2 cm.

Author:  Russell Jones, MD

References

1.  Jones J, Stanislavski A, et al.  Pulmonary Manifestations of HIV/AIDS.  http://radiopaedia.org/articles/pulmonary-manifestations-of-hiv-aids.  Accessed 10/2013.

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EMREMS: Radiology in Emergency Medicine

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