X-ray: Pneumocystis Pneumonia
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  • 1. Imaging of the week
    Dr.Anirudh J Shetty
    PROF.DR.DHANDAPANI’S UNIT
  • 2.
  • 3.
  • 4.
  • 5. 34 yr old unmarried male ,c/o
    fever without chills –2 days;
    breathlessness & hemoptysis-1 day;
    h/o non productive cough +
    No h/o haematuria
    No h/o chest pain /PND /orthopnea
    Not a known DM/HT/TB/IHD/BA/ pt.
    O/E
    emaciated,thin ,dyspneic,tachypneic
    vitals-BP -110/80 mmHg
    CVS-S1 ,S2 heard
    RS- bil.BB + in infrascapular,mammary ,inframammary and infraaxillary areas bil.creps.+
    other systems- NAD
  • 6. SUMMARY;
    -CHEST X RAY PA VIEW
    -ADEQUATELY PENETRATED
    -INSPIRATORY FILM
    -PROPERLY CENTRED
    -TRACHEA IN THE MIDLINE
    -SOFT TISSUES & BONE NORMAL
    -HEART SHADOWS NORMAL
    NON HOMOGENOUS OPACITIES SEEN BILATERALLY IN THE MID AND LOWER ZONES
    MORE ON THE LEFT SIDE
  • 7. DIFFERENTIAL DIAGNOSIS;
    ACUTE ALVEOLAR LUNG DISEASE
    “HEAP”
    Hemorrhage -Wegener granulomatosisSystemic lupus erythematosusGoodpasture syndrome Other vasculitides (e.g., polyarteritis
    nodosa, Henoch-Schönleinpurpura)
    Edema
    Alveolar proteinosis/Aspiration
    Pneumonia (includes infectious, organizing, and
    eosinophilic pneumonias)
  • 8. Pneumocystis PNEUMONIA
    RADIOLOGY;
    - bilateral diffuse opacities, perihilarinitially,with a lower zone predominance”ground glass “opacities
    -later air space consolidation pattern
    ATYPICAL PRESENTATIONS
    -solitary/multiple ;solid /cavitory nodular opacities
    -cystic lung disease
    -enlarged noncalcified/calcifiedhilar/mediastinal nodes
    -pleural effusion
    -air filled cysts/pneumatoceles causing pneumothorax
  • 9.
  • 10.
  • 11. CLINICAL FEATURES;
    non specific
    dyspnea,dry cough
    minimal signs –few crackles,wheeze
    unusual-asthma,hemoptysis,HPOA
    PCP related pneumothorax-sudden dyspneain AIDS patients
  • 12. EXTRAPULMONARY PCP;
    Virtually every organ system can be affected
    heart
    thyroid
    bonemarrow
    brain
    git
    skin
    other manifestations include otitis media and externa, sinusitis n splenomegaly
  • 13. Thank
    u