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. 2021 Sep;39(9):868-876.
doi: 10.1007/s11604-021-01122-8. Epub 2021 May 4.

Differentiation of pulmonary complications with extensive ground-glass attenuation on high-resolution CT in immunocompromised patients

Yoshie Kunihiro  1 , Nobuyuki Tanaka  2 , Reo Kawano  3 , Tsuneo Matsumoto  2 , Taiga Kobayashi  2 , Toshiaki Yujiri  4 , Makoto Kubo  5 , Toshikazu Gondo  6 , Katsuyoshi Ito  7
Affiliations

Differentiation of pulmonary complications with extensive ground-glass attenuation on high-resolution CT in immunocompromised patients

Yoshie Kunihiro et al. Jpn J Radiol. 2021 Sep.

Abstract

Purpose: The purpose of this study was to compare the high-resolution CT (HRCT) findings of pulmonary infectious and noninfectious complications with extensive ground-glass attenuation (GGA) in immunocompromised patients.

Materials and methods: One hundred fifty-two immunocompromised patients with pulmonary complications that showed extensive GGA (> 50% of the whole lung on HRCT) were included in this study. The diagnoses of the 152 patients were as follows: pneumocystis pneumonia (PCP), n = 82; drug-induced pneumonia, n = 38; bacterial pneumonia, n = 9; cytomegalovirus pneumonia, n = 6; idiopathic pneumonia syndrome, n = 6; diffuse alveolar hemorrhage (DAH), n = 4; fungal infection, n = 3; tuberculosis, n = 2 and pulmonary edema, n = 2. Two chest radiologists retrospectively evaluated the CT criteria, which consisted of 12 findings.

Results: The nodule (p = 0.015), the bronchovascular bundle (BVB) thickening (p = 0.001), and the interlobular septum (ILS) thickening (p = 0.002) were significantly infrequent in PCP. The ILS thickening was significantly frequent in drug-induced pneumonia (p < 0.001) though it was also frequent in other noninfectious and infectious diseases. The BVB thickening was significantly frequent in bacterial pneumonia (p = 0.005). The nodule was significantly frequent in DAH (p = 0.049).

Conclusion: Nodules, BVB thickening, and ILS thickening could be useful HRCT findings for the differential diagnosis of pulmonary complications in immunocompromised patients with extensive GGA.

Keywords: Ground-glass opacity; Immunocompromised host; Multivariate analysis; X-ray computed tomography.

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Conflict of interest statement

The authors have no conflict of interest to disclose with respect to this manuscript.

Figures

Fig. 1
Fig. 1
A 60-year-old man with pneumocystis pneumonia under treatment for acute lymphoid leukemia. High-resolution computed tomography shows extensive ground-glass attenuation with a mosaic pattern
Fig. 2
Fig. 2
A 61-year-old woman with drug-induced pneumonia under chemotherapy for colon cancer. High-resolution computed tomography shows ground-glass attenuation with outer distribution and thickening of the interlobular septum (arrows)
Fig. 3
Fig. 3
A 29-year-old man with bacterial pneumonia under treatment for acute leukemia. High-resolution computed tomography shows patchy ground-glass attenuation with bronchovascular bundle thickening (arrow)
Fig. 4
Fig. 4
A 56-year-old woman with diffuse alveolar hemorrhage under treatment for thrombocytopenia and uterine cancer. High-resolution computed tomography shows extensive ground-glass attenuation with multiple nodular lesions
See this image and copyright information in PMC

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