CT and Radiography of Bacterial Respiratory Infections in AIDS Patients
Chad W. Brecher1,
Galit Aviram2 and
Phillip M. Boiselle1
1 Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical
School, 330 Brookline Ave., Boston, MA 02215.
2 Department of Radiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv,
Israel.
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Fig. 1A. —Round pneumonia in 33-year-old HIV-positive woman. (Reprinted
with permission from [29])
Frontal chest radiograph reveals focal round consolidation overlying right
hilum.
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Fig. 1B. —Round pneumonia in 33-year-old HIV-positive woman. (Reprinted
with permission from [29])
Lateral chest radiograph localizes consolidation to right middle lobe.
Bacterial pneumonia may occasionally display round appearance. In such cases,
follow-up radiographs are important to document resolution and to exclude
neoplastic mass.
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Fig. 2. —Cavitary Pseudomonas aeruginosa in
47-year-old HIV-positive man with advanced immune suppression. CT scan (lung
window setting) at level of right upper lobe bronchus shows cavitary pneumonia
in right upper lobe. Note diffuse bilateral ground-glass opacities and
loculated pleural fluid collection lateral to area of cavitation.
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Fig. 3. —Cavitary nodules due to septic emboli in 32-year-old woman
with risk factor of IV drug abuse. CT scan (lung window setting) at level of
superior segment bronchi shows multiple peripheral lung nodules, some of which
show cavitation. Note bilateral pleural effusions.
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Fig. 4A. —Pneumococcal pneumonia complicated by empyema in 33-year-old
HIV-positive man. Scout frontal image of chest from CT scan shows increased
opacity in left retrocardiac region with few air bronchograms.
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Fig. 4B. —Pneumococcal pneumonia complicated by empyema in 33-year-old
HIV-positive man. Coned-down CT scan (soft-tissue window setting) of left
lower lobe shows necrotizing pneumonia and adjacent loculated pleural effusion
(E), which are due to empyema.
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Fig. 4C. —Pneumococcal pneumonia complicated by empyema in 33-year-old
HIV-positive man. Coned-down CT scan (soft-tissue window setting) of left
upper lobe reveals additional loculated pleural fluid collection (E) in major
fissure.
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Fig. 5A. —Rapidly progressive pneumococcal pneumonia in 50-year-old
HIV-positive man. (Reprinted with permission from
[3]) Portable frontal chest
radiograph reveals focal areas of consolidation in lingula and left lower
lobe.
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Fig. 5B. —Rapidly progressive pneumococcal pneumonia in 50-year-old
HIV-positive man. (Reprinted with permission from
[3]) CT scan (lung window
settings) of lower chest obtained as part of abdominal CT scan 1 day after
A shows progressive consolidation in lingula and left lower lobe.
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Fig. 5C. —Rapidly progressive pneumococcal pneumonia in 50-year-old
HIV-positive man. (Reprinted with permission from
[3]) Portable frontal chest
radiograph obtained 1 day after B shows rapid progression of pneumonia,
which now involves left lung diffusely. Patient was treated with intubation
for respiratory failure but responded to appropriate antibiotic therapy and
fully recovered.
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Fig. 6. —Cavitary pneumonia due to Rhodococcus equi infection
in 34-year-old HIV-positive man. CT scan (lung window setting) obtained at
level of carina shows peripheral focus of cavitary consolidation in left upper
lobe. Note subtle foci of ground-glass attenuation in adjacent lung
parenchyma. (Courtesy of Costello P, Boston, MA)
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Fig. 7. —Lung nodules due to bacillary angiomatosis in 38-year-old
HIV-positive man who presented with skin lesions and had HIV risk factor of IV
drug abuse. CT scan (lung window setting) obtained at level of mainstem
bronchi shows numerous scattered lung nodules (arrows), which are
randomly distributed. Several nodules abut pleural surfaces (contrast
appearance with centrilobular nodules in
Figure 8 that spare pleural
surfaces). Random distribution of nodules can be seen in hematogenous spread
of infection or neoplasm. Note bilateral pleural effusions. (Courtesy of White
C, Baltimore, MD)
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Fig. 8. —Pyogenic airways disease in 39-year-old HIV-positive man with
recurrent respiratory infections. High-resolution CT scan of lung bases shows
multilobar bronchial dilation, bronchial wall thickening, and bronchiolitis
(arrow). Note clustering of small nodular and branching opacities
that spare pleural surfaces. Such centrilobular distribution is highly
suggestive of infectious cause. Note minimal foci of peripheral consolidation
in right middle lobe and lingula. (Reprinted with permission from
[3])
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Copyright © 2003 by the American Roentgen Ray Society.
