Pulmonary Disease in Patients with AIDS: High-Resolution CT and Pathologic Findings
Edson Marchiori1,
Nestor L. Müller2,
Arthur Soares Souza, Jr.3,
Dante Luiz Escuissato4,
Emerson Leandro Gasparetto4 and
Tomás Franquet5
1 Department of Radiology, Hospital Clementino Fraga, Universidade Federal
Fluminense e Universidade Federal do Rio de Janeiro, Rio de Janeiro,
Brazil.
2 Department of Radiology, Vancouver General Hospital, University of British
Columbia, 899 W 12th Ave., Vancouver, BC V5Z 1M9, Canada.
3 Department of Radiology, Hospital de Base da Faculdade de Medicina (FAMERP) e
Instituto de Radiodiagnóstico Rio Preto, São José do Rio
Preto, São Paulo, Brazil.
4 Department of Diagnostic Radiology, University of Paraná, Curitiba,
Brazil.
5 Departmento de Radiologia, Hospital de Sant Pau, Avda San Antonio M. Claret
167, Barcelona 08025, Spain.
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Fig. 1A. —32-year-old man with AIDS and Pneumocystis carinii
pneumonia. High-resolution CT scan shows bilateral areas of ground-glass
attenuation. Note sharp demarcation between abnormal and normal parenchyma and
mild smooth thickening of some of interlobular septa.
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Fig. 1B. —32-year-old man with AIDS and Pneumocystis carinii
pneumonia. Photomicrograph of histologic specimen shows septal thickening
(straight arrows) secondary to edema and cellular inflammatory
infiltrates separating two secondary lobules. Note partial filling of air
spaces by inflammatory infiltrate (curved arrows), which accounts for
ground-glass opacities seen on CT scan (A). (H and E, x40)
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Fig. 2A. — 42-year-old woman with AIDS and miliary tuberculosis.
High-resolution CT scan shows numerous small nodules in random
distribution.
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Fig. 2B. — 42-year-old woman with AIDS and miliary tuberculosis.
Photomicrograph of whole-mount, low-power histologic section reveals multiple
granulomas (arrows) with necrotic centers. (H and E, x40)
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Fig. 3A. —44-year-old woman with AIDS and bacterial pneumonia. High-resolution
CT scan shows foci of air-space consolidation with adjacent ground-glass
attenuation in dorsal lung regions. Also note branching linear and nodular
opacities resulting in tree-in-bud pattern (arrows).
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Fig. 3B. —44-year-old woman with AIDS and bacterial pneumonia. Photomicrograph
of histologic specimen shows bronchiolar bifurcation with inflammatory
infiltrate in lumen (straight arrow) and in peribronchiolar region
(curved arrows), corresponding to tree-in-bud pattern shown on
high-resolution CT. (H and E, x40)
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Fig. 4A. —19-year-old man with AIDS and miliary histoplasmosis.
High-resolution CT scan shows numerous small nodules in random
distribution.
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Fig. 4B. —19-year-old man with AIDS and miliary histoplasmosis.
Photomicrograph of histologic section reveals granulomas, some of which are
confluent in parenchymal interstitium. (H and E, x40)
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Fig. 5A. —62-year-old man with AIDS and invasive pulmonary aspergillosis.
High-resolution CT scan obtained at level of upper lobes shows nodule with
surrounding halo of ground-glass attenuation (arrows) in right upper
lobe.
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Fig. 5B. —62-year-old man with AIDS and invasive pulmonary aspergillosis.
High-resolution CT scan obtained at level of middle and lower lobes shows
small nodules in lingula and left lower lobe (arrows) and localized
scarring in right lower lobe.
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Fig. 5C. —62-year-old man with AIDS and invasive pulmonary aspergillosis.
Photomicrograph of histologic specimen of one of small nodules shows necrotic
center (straight arrows) surrounded by leukocytic infiltrate
(curved arrows) and more peripherally by alveolar hemorrhage
(arrowheads). (H and E, x40)
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Fig. 5D. —62-year-old man with AIDS and invasive pulmonary aspergillosis. On
photomicrograph of histologic specimen, black of Grocott-Gomori
methenamine–silver nitrate stain reveals hyphae of Aspergillus
organisms with radial distribution inside nodule from center to periphery.
(x40)
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Fig. 6A. —37-year-old man with AIDS and cryptococcal infection.
High-resolution CT scan shows numerous small nodules in random distribution,
characteristic of miliary disease.
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Fig. 6B. —37-year-old man with AIDS and cryptococcal infection.
Photomicrograph of histologic section shows one of the nodules
(arrow). (H and E, x40).
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Fig. 7. —38-year-old man with AIDS and Cytomegalovirus pneumonia.
High-resolution CT scan shows bilateral nodules (straight arrows),
focal ground-glass opacities (curved arrows), and consolidation
(arrowhead).
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Fig. 8A. —34-year-old man with AIDS and Kaposi's sarcoma. High-resolution CT
scan shows marked peribronchial thickening, perivascular nodularity
(straight arrows), nodules along interlobar fissures (curved
arrows), and thickening of interlobular septa.
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Fig. 8B. —34-year-old man with AIDS and Kaposi's sarcoma. High-resolution CT
scan obtained at more caudal level than A shows extensive interlobular
septal thickening and centrilobular nodules (arrows).
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Fig. 8C. —34-year-old man with AIDS and Kaposi's sarcoma. Photomicrograph of
histologic specimen shows edema and tumor cells, which produce thickening of
interlobular septa (arrows). (H and E, x40)
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Fig. 8D. —34-year-old man with AIDS and Kaposi's sarcoma. Photomicrograph of
histologic specimen shows tumor cells infiltrating peribronchiolar connective
tissue, which results in centrilobular nodules seen on high-resolution CT. (H
and E, x40)
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Fig. 9A. —52-year-old man with AIDS and non-Hodgkin's lymphoma.
High-resolution CT scan shows bilateral consolidation in predominantly
peribronchial distribution, nodule in lingula (straight arrow), and
few centrilobular nodules (curved arrows).
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Fig. 9B. —52-year-old man with AIDS and non-Hodgkin's lymphoma.
Photomicrograph of histologic section shows infiltration around bronchiole and
arteriole by tumor cells. Such infiltration results in centrilobular nodular
opacities seen on high-resolution CT. (H and E, x40)
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Fig. 10A. —24-year-old woman with AIDS and lymphocytic interstitial pneumonia.
High-resolution CT scan shows patchy bilateral ground-glass opacities, small
foci of consolidation, mild septal thickening (straight arrows), and
few small nodules (curved arrows).
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Fig. 10B. —24-year-old woman with AIDS and lymphocytic interstitial pneumonia.
Photomicrograph of histologic specimen shows lymphocyte aggregates resulting
in nodular appearance (straight arrows). In some areas, lesions are
abundant (curved arrows) and result in collapse of alveolar spaces,
which results in ground-glass opacities and air-space consolidation seen on
high-resolution CT. (H and E, x40)
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Fig. 11. —7-year-old boy with AIDS and nonspecific interstitial pneumonia.
High-resolution CT scan shows patchy bilateral ground-glass opacities, small
foci of consolidation, and poorly defined centrilobular nodular opacities
(arrows).
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Copyright © 2005 by the American Roentgen Ray Society.
