Radiographic and HRCT Findings of Pneumocystis Carinii Pneumonia

Abstract

Purpose : To analyze the radiographic and HRCT findings of Pneumocystic carinii pneumonia. Materials and Methods : We reviewed the medical records and retrospectively analysed the chest radi-ographs(n=31) and HRCT scans(n=17) of 31 patients with Pneumocystis carinii pneumonia who had been fol-lowed up at our institute between, 1993 and March 1998. Pneumocystis carinii pneumonia was confirmed by cytologic evaluation of sputum stained with methenamine silver(n=25) or on the basis of clinical history(n=6). The study group included 17 men and 14 women aged 28 -78(average, 53.6) years. Twenty-eight patients had underlying conditions such as hematologic diseases(n=13), AIDS(n=8), malignancy(n=2), DM(n=2) and mal-nutrition(n=1), and three were free from underlying diseases. Results : Twenty patients had pure Pneumocystis carinii pneumonia and 11 had combined lung diseases, namely pulmonary tuberculosis(n=4), pulmonary metastasis(n=2), bacterial pneumonia(n=2), atypical my-cobacterial infection(n=1), pulmonary edema(n=1), and Kaposi ’s sarcoma(n=1). Chest radiographic findings of 20 cases of pure Pneumocystis carinii pneumonia included consolidation(n=12), l inear-reticular opacity(n=8), ill defined haziness(n=7), and nodules(n=6), with bilaterality in is cases and zonal predomi-nance in ten [central(n=5), lower(n=5)]. Ancillary findings included pleural effusion(n=10), cysts(n=5), lym-phadenopathy(n=4) and pneumothorax(n=1). In two patients, findings were entirely normal. HRCT findings in ten cases of pure Pneumocystis carinii pneumonia included ground-glass opacity(n=6), consolidation(n=6), linear-reticular opacity(n=8), and nodules(n=5), with bilaterallity in seven cases and zonal predominance in five [central(n=5), lower(n=2)]. Ancillary findings among these cases included pleural effusion(n=4), lym-phadenopathy(n=2), cysts(n=1), and pneumothorax(n=1). HRCT findings in seven cases of Pneumocystis carinii pneumonia combined with other lung diseases included nodules(n=6), ground-glass opacity(n=5), lin-ear-reticular opacity(n=4), and consolidation(n=3). Conclusion : Although ground-glass opacity in both pure Pneumocystis carinii pneumonia and this same con-dition combined with other lung diseases is a common radiologic finding, the possibility of variable radiologic findings in cases of Pneumocystis carinii pneumonia and other lung diseases with which it frequently com-bines is essential for approximate diagnosis of Pneumocystis carinii pneumonia.