HRCT findings in HIV-AIDS patients

1. Pulmonary manifestations in
Immuno compromised Host
Dr.Mitusha Verma
Dept. Of Radiodiagnosis.
Dr.B.Nanavati Hospital.

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. SYSTEMATIC APPROACH
• History –IVDAs , CMV , Kaposi’s sarcoma.
• Examination
• Investigations – Sputum
CD4 Counts
• Chest X ray
• HRCT
• Fiberoptic bronchoscopy with BAL

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. IMAGING

6. • CHEST RADIOGRAPH
• HRCT
A normal CT chest virtually rules out an active
pneumonia as the site of infection.

7. Radiologic Patterns
Ground Glass Opacities
Consolidation
Multiple Pulmonary
Nodules
Lymphadenopathy
Pleural Effusion
Endobronchial Spread
Disseminated Disease

8. Ground Glass Opacities
Virtually diagnostic of PJP
May be seen with
CMV
Herpes
Lymphocytic interstitial pneumonia

9. Consolidation
Focal segmental or Lobar Air space consolidations
Characterstic Of Community acquired Pneumonias
May be seen with TB ; Rhodococcus ; Nocardia

10. Multiple Pulmonary Nodules
• 1-3mm Milliary nodules
MC –Mycobacterial infection ; Histoplasmosis , Coccidioimycosis

11. Multiple Pulmonary Nodules
• < 1 cm Nodules
Seen with
• CMV
• Cryptococcus
Associated with reticular
pattern.

12. Multiple Pulmonary Nodules
• 1-2 cm nodules
Multiple Cavitatory Nodules
With wedge shaped opacities –
septic emboli.

13. Multiple Pulmonary Nodules
• 1-2 cm nodules
Multiple Cavitatory Nodules ; peripheral / sub pleural
With wedge shaped opacities –
septic emboli.

14. Multiple Pulmonary Nodules
• Wedge shaped larger Nodules with HALO
Pleural Based Opacities
Seen in invasive aspergillosis

15. Multiple Pulmonary Nodules
Larger Nodules – Lymphoma ; Metastases

16. Multiple Pulmonary Nodules
Typically clustered along the bronchovascular bundles
Kaposi’s Sarcoma

17. Solitary Pulmonary Nodules
Primary Bronchogenic Carcinoma

18. Lymphadenopathy
• MC cause of mediastinal LNs – Mycobacterial Infections
• With Calcification – Disseminated PJP
• With intense enhancement – Kaposi’s Sarcoma

19. Pleural Effusion
• Massive effusion with lymphocytes on cytology – TB.
• Hemorrhagic fluid –Kaposi’s Sarcoma.

20. Endobronchial Spread
• Bronchitis , Bronchiolitis ,Bronchiectasis
• Seen with Pyogenic Infectious Airway Disease

21. Few Entities to revise…

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. Patchy but extensive ground-glass opacity throughout both lungs.

24. Crazy paving characterized by extensive ground-glass
opacity with superimposed interlobular septal thickening and
intralobular lines. Relative subpleural sparing is evident.

25. Consolidation.

26. Pulmonary cysts associated with increased
frequency of spontaneous pneumothorax

27. Solitary nodule or mass mimicking lung
carcinoma or as multiple nodules ranging from
a few millimeters to more than 1 cm

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. 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. Mycobacterial Infection
• Consolidations
• Endobranchial Nodules
• Cavitations
• Pleural Effusion
• Mediastinal
Adenopathy
• Dissemination

31. Viral Infection
MC – CMV
CD4 counts < 50
Imaging –
•Ground Glass Opacities
•ARDS like Pattern
•Nodules
•Bronchiectasis
•Bronchial Wall Thickening.

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. LYMPHOCYTIC INTERSTIAL
PNEUMONITIS
Benign lymphoproliferative disorder
characterised by lymphocyte predominant
infiltration of the lungs .

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. Diffuse Flame Shaped Nodular Opacities
Kaposi’s Sarcoma

36. •THANK YOU…..