Pulmonary manifestations in immuno compromised host

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HRCT findings in HIV-AIDS patients

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Pulmonary manifestations in immuno compromised host

  1. 1. Pulmonary manifestations in Immuno compromised Host Dr.Mitusha Verma Dept. Of Radiodiagnosis. Dr.B.Nanavati Hospital.
  2. 2. • ICH – special group as predisposed to both opportunistic and non – opportunistic organisms. • ICH patients rising with – - rise in incidence of HIV/AIDS. - solid organ or bone marrow transplant.
  3. 3. SYSTEMATIC APPROACH • History –IVDAs , CMV , Kaposi’s sarcoma. • Examination • Investigations – Sputum CD4 Counts • Chest X ray • HRCT • Fiberoptic bronchoscopy with BAL
  4. 4. CD4 Counts >500 cells/mm3- recurrent community acquired pneumonias ; reactivation TB. 200- 500 -Lymphoproliferative disorders and Primary Lung Carcinoma. < 200 - Pneumocystis Jeroveci Pneumonia ; disseminated tuberculosis < 100 – Kaposi’s Sarcoma < 50 – Viral pneumonias , Atypical mycobacterial Infectins ; Fungal infections
  5. 5. IMAGING
  6. 6. • CHEST RADIOGRAPH • HRCT A normal CT chest virtually rules out an active pneumonia as the site of infection.
  7. 7. Radiologic Patterns Ground Glass Opacities Consolidation Multiple Pulmonary Nodules Lymphadenopathy Pleural Effusion Endobronchial Spread Disseminated Disease
  8. 8. Ground Glass Opacities Virtually diagnostic of PJP May be seen with CMV Herpes Lymphocytic interstitial pneumonia
  9. 9. Consolidation Focal segmental or Lobar Air space consolidations Characterstic Of Community acquired Pneumonias May be seen with TB ; Rhodococcus ; Nocardia
  10. 10. Multiple Pulmonary Nodules • 1-3mm Milliary nodules MC –Mycobacterial infection ; Histoplasmosis , Coccidioimycosis
  11. 11. Multiple Pulmonary Nodules • < 1 cm Nodules Seen with • CMV • Cryptococcus Associated with reticular pattern.
  12. 12. Multiple Pulmonary Nodules • 1-2 cm nodules Multiple Cavitatory Nodules With wedge shaped opacities – septic emboli.
  13. 13. Multiple Pulmonary Nodules • 1-2 cm nodules Multiple Cavitatory Nodules ; peripheral / sub pleural With wedge shaped opacities – septic emboli.
  14. 14. Multiple Pulmonary Nodules • Wedge shaped larger Nodules with HALO Pleural Based Opacities Seen in invasive aspergillosis
  15. 15. Multiple Pulmonary Nodules Larger Nodules – Lymphoma ; Metastases
  16. 16. Multiple Pulmonary Nodules Typically clustered along the bronchovascular bundles Kaposi’s Sarcoma
  17. 17. Solitary Pulmonary Nodules Primary Bronchogenic Carcinoma
  18. 18. Lymphadenopathy • MC cause of mediastinal LNs – Mycobacterial Infections • With Calcification – Disseminated PJP • With intense enhancement – Kaposi’s Sarcoma
  19. 19. Pleural Effusion • Massive effusion with lymphocytes on cytology – TB. • Hemorrhagic fluid –Kaposi’s Sarcoma.
  20. 20. Endobronchial Spread • Bronchitis , Bronchiolitis ,Bronchiectasis • Seen with Pyogenic Infectious Airway Disease
  21. 21. Few Entities to revise…
  22. 22. • Atypical fungus • Particularly with deficiency in cell-mediated immunity. Pathogenesis- • P. jiroveci lives almost exclusively in the pulmonary alveoli, adhering to the alveolar epithelium. • Intraalveolar macrophages serve as the primary host defense against P. jiroveci, and macrophage deficiency or dysfunction can lead to infection. Pneumocystis Jeroveci Pneumonia
  23. 23. Patchy but extensive ground-glass opacity throughout both lungs.
  24. 24. Crazy paving characterized by extensive ground-glass opacity with superimposed interlobular septal thickening and intralobular lines. Relative subpleural sparing is evident.
  25. 25. Consolidation.
  26. 26. Pulmonary cysts associated with increased frequency of spontaneous pneumothorax
  27. 27. Solitary nodule or mass mimicking lung carcinoma or as multiple nodules ranging from a few millimeters to more than 1 cm
  28. 28. HRCT Extensive ground-glass opacity is the principal finding in PJP. With more advanced disease, septal lineson ground-glass opacity –crazy paving. Consolidation.  Pulmonary cysts associated with increased frequency of spontaneous pneumothorax Solitary nodule or mass mimicking lung carcinoma or as multiple nodules ranging from a few millimeters to more than 1 cm Small nodules and tree-in-bud opacities are uncommon Residual interstitial fibrosis - chronic Pneumocystis pneumonia .
  29. 29. MYCOBACTERIAL INFECTIONS • HIV patients have 50 -200 times more risk of TB • TB accelerates the progression of HIV • CD4 > 200 – upper lobe opacity with cavitation and nodular bronchogenic spread • CD4 < 200 – Parenchymal consolidation , lymph nodes with necrosis , pleural effusion , extrapulmonary spread.
  30. 30. Mycobacterial Infection • Consolidations • Endobranchial Nodules • Cavitations • Pleural Effusion • Mediastinal Adenopathy • Dissemination
  31. 31. Viral Infection MC – CMV CD4 counts < 50 Imaging – •Ground Glass Opacities •ARDS like Pattern •Nodules •Bronchiectasis •Bronchial Wall Thickening.
  32. 32. Fungal Infection MC – Cryptococcosis Invasive aspergillosis Disseminated Candidiasis CD4 counts < 50 Aspergillosis Imaging – •Nodular opacities abutting the pleurla surface. •Cavitate – Air crescent Sign •HALO –Hemorrhage •Necrotising tracheobronchial involvement.
  33. 33. LYMPHOCYTIC INTERSTIAL PNEUMONITIS Benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs .
  34. 34. LYMPHOCYTIC INTERSTIAL PNEUMONITIS HRCT Difuse involvement . Mediastinal lymphadenopathy . Ground-glass change . Scattered thin walled cysts - usually deep within the lung parenhyma and range from 1- 30 mm (useful for differentiation between lymphoma or the lung ) . Intersitital thickening along lymph channels . Thickening of bronchovascular bundles Small but variably sized pulmonary nodules (
  35. 35. Diffuse Flame Shaped Nodular Opacities Kaposi’s Sarcoma
  36. 36. •THANK YOU…..

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