Lung Nodules and Masses in Patients Who Are Not HIV Immunocompromised: A Clinical Imaging Algorithmic Approach

Abstract

Topic importance: The incidence of pulmonary nodules and masses in immunocompromised patients without HIV has significantly increased due to advancements in hematopoietic stem cell transplantation and solid organ transplantation and the widespread use of chemotherapy and immunosuppressive therapies. Differentiating between infectious and noninfectious causes is critical for appropriate diagnosis and management, especially because radiologic and clinical presentations can be nonspecific.

Review findings: This review provides a practical framework for evaluating pulmonary nodules and masses in immunocompromised patients without HIV, incorporating clinical, immunologic, and radiologic features. It emphasizes the importance of differentiating between infectious and noninfectious etiologies based on imaging and clinical context. The review highlights the importance of correlating imaging features with the patient's immune status and underlying clinical conditions to narrow down the differential diagnosis.

Summary: Pulmonary nodules and masses in immunocompromised patients represent a diagnostic challenge due to overlapping radiologic and clinical presentations. By integrating clinical context, immune status, and imaging findings, clinicians can more accurately diagnose and manage these lesions, improving patient outcomes. This review presents an algorithmic approach for differentiating between various causes of pulmonary nodules and masses in immunocompromised individuals without HIV, providing a valuable tool for clinical practice.

Keywords: CT scan findings; hematopoietic stem cell transplantation; immunocompromised host; infective etiologies; lung masses; neoplasms; noninfective etiologies; opportunistic infections; patients without HIV; pulmonary nodules; solid organ transplantation.