High Resolution Computed Tomography Lung Spectrum in Symptomatic Adult HIV-Positive Patients in South-East Asian Nation

Abstract

Background: Pulmonary infections remain a leading cause of morbidity and mortality and one of the most frequent causes of hospital admission in HIV infected people worldwide. HRCT may be useful in the evaluation of patients with suspected pulmonary disease. The aim of given study was to determine the High Resolution Computed Tomography spectrum of lung parenchymal and interstitial imaging findings in HIV infected patients presented with chest symptoms.

Materials and methods: This study was conducted in a tertiary health care centre, New Delhi, India. The study consisted of 45 patients. A thorough clinical history of all the HIV positive patients presenting with suspicion of pulmonary disease was taken. General physical and respiratory system examination of all patients was done. HRCT scans of the chest were done in all the cases taken in the study.

Results: Maximum number of patients was in age group 31-40 years (24 cases). Out of 45 patients included in our study, 32 (71%) were male and 13 (29%) were female. In our series of 45 patients, 62.2% of patients were diagnosed as having pulmonary tuberculosis, followed by bacterial infection in 20% cases and Pneumocystis jiroveci pneumonia (PJP) in 8.9% patients, while 8.9% of the study did not reveal any significant abnormality. Maximum number (22/28) of patients with pulmonary tuberculosis were indentified to have nodular opacities. The most common HRCT finding in bacterial infection was lobar consolidation. The most common HRCT finding in patients with PCP was diffuse ground glass opacities in mosaic pattern of distribution.

Conclusion: HRCT is a highly sensitive tool for detecting lung parenchymal and interstitial lesions and allows better characterization of the lesions. HRCT findings should always be correlated with clinical findings, CD4 counts and other available investigations before arriving at a diagnosis or differential diagnosis.

Keywords: Bacterial infection; High resolution computed tomography; Human immunodeficiency virus; Pneumocystis jiroveci pneumonia; Pulmonary tuberculosis; Radiologic patterns.

[Table/Fig-1]:

Disease Spectrum

[Table/Fig-3]:

Scan showing areas of consolidation with cavitation within (arrows). Multiple centrilobular nodules showing clustering and tree-in-bud pattern (thick arrow). Case of pulmonary tuberculosis

[Table/Fig-5]:

HIV-positive patient with bacterial pneumonia. Axial HRCT (a) lung window (b) mediastinal window. Area of consolidation seen involving posterior segment of right upper lobe with adjacent areas of ground glass opacity

[Table/Fig-7]:

Axial HRCT image (a) and coronal reformatted (b) images show cystic bronchiectasis with air fluid level in left lower lobe. Areas of bronchiectasis are also seen in both the upper lobes. Diagnosis: Bronchiectasis with secondary bacterial infection

[Table/Fig-9]:

Multiple nodules are seen in the visualized lung fields. Most of the nodules are evenly spaced and not touching the pleural surface. Few areas show clustering of nodules. Centrilobular nodules in a case of pulmonary tuberculosis

[Table/Fig-10]:

29 year old HIV-positive patient. HRCT axial images (a) through upper lobes (b) subcarinal level shows areas of crazy paving and multiple tiny cysts. Focal area of consolidation is also seen in right side. Pneumomediastinum is also noted. Pneumocystis jiroveci pneumonia