Pulmonary toxoplasmosis in AIDS.

The chest radiographs obtained in nine patients with acquired immunodeficiency syndrome (AIDS) and pulmonary toxoplasmosis were reviewed. In three patients, a bilateral, diffuse, fine to medium reticulonodular pattern indistinguishable from that seen in Pneumocystis carinii pneumonia (PCP) was observed. In six patients, however, a bilateral, predominantly coarse, nodular pattern was observed. This type of abnormality is unusual with PCP, and its presence may help in distinguishing between pulmonary infections caused by Toxoplasma gondii and P carinii. Other opportunistic pneumonias occurring in patients with AIDS, including tuberculosis, histoplasmosis, and coccidioidomycosis, might show similar coarse, nodular opacities on chest radiographs and thus may not be differentiated from pulmonary toxoplasmosis. No hilar or mediastinal adenopathy was observed. Two patients had pleural fluid. Radiologists familiar with the chest radiographic appearance of T gondii pneumonia could be first to suggest this unusual complication of AIDS.     

艾滋病合并肺结核的影像学特征分析

目的探讨艾滋病合并肺结核病的影像学特征方法回顾性分析21例艾滋病合并肺结核患者胸部X线平片和CT表现,并与40例单纯肺结核患者对照结果21例艾滋病合并肺结核中,15例病变发生在单纯继发性肺结核非好发部位,14例累及2个或以上肺段,12例影像学表现为小片状淡薄影,7例伴弥漫粟粒性病灶,11伴肺门和/或纵隔淋巴结肿大,6例伴有肺外结核而40例单纯肺结核中有29例发生在上叶的尖后段、下叶的背段,30例仅累及1个肺段,31例影像表现为致密的斑片影,23例伴有纤维增殖灶,19例有1个或多个空洞两者差异有统计学意义结论艾滋病合并肺结核与单纯肺结核在影像学表现上有明显差别     

Pulmonary mycosis caused by Paracoccidioides brasiliensis: dangerous confusion with sarcoidosis

We present the case of a patient from South America with a lung disease that was initially diagnosed as sarcoidosis and treated with corticoids. Despite an initial improvement, the patient worsened gradually until his condition was finally attributed to paracoccidioidomycosis. This systemic mycosis has features in common with sarcoidosis, but the treatment differs drastically because corticoids can place the patient's life at risk.     

艾滋病并发粟粒型肺结核的CT表现

目的：探讨艾滋病并发粟粒型肺结核的CT影像表现及临床特点,以提高肺部弥漫性粟粒性病变的临床影像诊断水平。方法：回顾性分析本院临床确诊的9例艾滋病并发粟粒型肺结核和42例单纯粟粒型肺结核的CT影像检查及临床相关资料,观察肺粟粒结节的大小、分布、密度、磨玻璃影、结节边缘征象等,以及观察纵隔淋巴结肿大、胸腔、心包积液的程度。结果：9例艾滋病伴粟粒型肺结核结节大小一致3例,分布均匀4例,密度均匀2例,磨玻璃影8例,结节边缘模糊6例,合并有纵隔淋巴结肿大6例,胸腔积液7例,心包积液5例,肺外结核6例。42例单纯粟粒型肺结核中,结节大小一致32例（76%）,结节分布均匀37例（80%）,密度均匀33例（78%）,磨玻璃影3例（7%）,结节边缘模糊8例（17%）,合并有纵隔淋巴结肿大12例（28%）,胸腔、心包积液11例（23%）。结论：艾滋病伴粟粒型肺结核与单纯粟粒型肺结核在结节分布、大小和密度、结节边缘征像以及合并纵隔淋巴结肿大、浆膜腔积液、肺外结核等方面差异有显著性意义（P〈0.05）。了解其相关临床影像表现特征有利于艾滋病并发肺结核的早期诊断和治疗。     

Pulmonary neoplastic and lymphoproliferative disease in AIDS: a review

Kaposi sarcoma and lymphoma are the most common forms of neoplastic disease encountered in patients with acquired immunodeficiency syndrome (AIDS). Pulmonary involvement is fairly common with Kaposi sarcoma, while lymphoma only rarely involves the lungs. There has been a significant increase in the number of AIDS patients who develop Kaposi sarcoma, especially male homosexuals. There has also been an increase in the incidence of high-grade (aggressive) lymphoma in male homosexuals (and young men in general). Lymphoid interstitial pneumonia is a chronic condition that primarily affects adults and is becoming more common in patients with AIDS. When present in children less than 13 years old, lymphoid interstitial pneumonia is considered to be an indication of AIDS. Bronchus-associated lymphoid tissue and a condition resembling angioimmunoblastic lymphadenopathy are also being found in children with AIDS. A review of the literature on neoplastic and lymphoproliferative disease in AIDS suggests that a variety of lymphoproliferative disorders in AIDS can be expected in the future.     

Pulmonary tuberculosis and other mycobacterial infections in patients with AIDS]

Nowadays, the acquired immune deficiency syndrome (AIDS) is most certainly the major cause of the increased incidence of tuberculosis (TBC). A total of 138 patients (pts) with AIDS were referred to the Department of Infectious Diseases of the Hospital of Pisa, 1990-1991; 14 of them (10.1%) presented pulmonary TBC. In our study, we analyzed the chest films of the latter group of patients. Based on the X-ray patterns, the findings were classified as follows: hilar lymph nodes were observed in 4 pts (28.6%), isolated lymph nodes in 2 cases; associated with parenchymal involvement in 2 pts; acute alveolar TBC was seen in 4 cases (28.6%), with escavations in 3/4 (21.4%). Linear and reticular TBC were found in 4 pts (28.6%), and miliary interstitial involvement in 1 case (7%), extrapulmonary adenopathy in 4 pts (28.6%). In 4 pts (28.6%) chest X-ray findings were negative. All pts underwent serial chest X-rays in the course of therapy. HRCT was performed in 6 patients: our results are in agreement with those reported in literature. Thus, we can conclude that the major diagnostic findings in our series were: frequent isolated involvement of hilar lymph nodes, as observed in primary TBC; the infiltrates are most frequently located in the middle and basal lobes; escavations are uncommon; pleural effusion is unusual; in some pts chest X-ray findings may be negative.     

Pulmonary manifestations of AIDS: review of 106 episodes

We reviewed the clinical records and chest radiographs of all patients admitted to our institution between 1982 and 1984 who had pulmonary disease and who were later proved to have acquired immunodeficiency syndrome (AIDS) (95 patients). Diffuse parenchymal lung disease was the most common finding. These infiltrates were usually interstitial and caused by Pneumocystis carinii pneumonia or P. carinii combined with cytomegalovirus infection. Focal, multilobar, interstitial infiltrates were also often seen and usually caused by P. carinii or P. carinii and cytomegalovirus infections. Rarely, well-defined, multiple, interstitial nodules less than 10 mm in diameter were the only or predominant characteristic and were seen only in association with Mycobacterium tuberculosis or Cryptococcus neoformans infections or Kaposi sarcoma. Hilar or mediastinal adenopathy occurred in 17 of the 21 patients with M. tuberculosis or C. neoformans infections. In contrast, only 4% of patients with P. carinii infections presented with these findings. We also found that hilar or mediastinal adenopathy was not significantly associated with peripheral adenopathy. Lung cavitation, pleural effusion, or a normal chest radiograph was uncommon.     

Pulmonary cysts associated with Pneumocystis carinii pneumonia in patients with AIDS

A diffuse, bilateral interstitial infiltrate is the most common radiographic finding in Pneumocystis carinii pneumonia (PCP) in patients with the acquired immunodeficiency syndrome (AIDS). However, atypical roentgenographic patterns also exist. Chest radiographs of 100 consecutive AIDS patients with PCP were retrospectively analyzed for the presence of pulmonary air-filled cysts, or pneumatoceles, which were identified in 10% of the cases. The pneumatoceles were typically thin-walled with no intracystic material and no predilection for a particular area of the lung. They appear to behave like pneumatoceles due to other infectious processes. They were present on the initial radiograph or developed during treatment of PCP. Analysis of available follow-up radiographs indicated resolution of the pulmonary cysts within 7 months in most cases. The cause of these cysts is unknown, but a "check-valve" obstruction or, perhaps less likely, parenchymal necrosis may be involved. Rupture of these pulmonary cysts may lead to spontaneous pneumothorax.     

Pulmonary paracoccidioidomycosis and AIDS: high-resolution CT findings in five patients

OBJECTIVE: To study the high-resolution computed tomographic (HRCT) findings in patients with AIDS and pulmonary paracoccidioidomycosis (PCM). MATERIALS AND METHODS: The study included 5 consecutive patients (4 men and 1 woman, with ages ranging between 35 and 57 years; mean, 48 years) with diagnosis of AIDS and pulmonary PCM. All patients underwent HRCT, and the images were reviewed by 2 radiologists who reached decisions by consensus. RESULTS: The predominant HRCT findings in the present series were large nodules (80%), cavited air-space consolidations (80%), ground-glass attenuation (80%), and cicatricial emphysema in the bases (80%). These lesions predominated bilaterally in the middle regions (80%) of the lungs. CONCLUSIONS: The most common HRCT features in patients with AIDS and pulmonary PCM are large nodules associated with cavitated air-space consolidations and ground-glass attenuation, as well as cicatricial emphysema in the pulmonary bases. These findings are usually distributed bilaterally in the middle lung zones of the lungs.     

艾滋病合并马尔尼菲青霉菌感染的胸部影像学诊断价值

目的 探讨艾滋病(AIDS)合并马尔尼菲青霉菌(PM)感染的患者胸部影像学表现及其与临床治疗后转归的关系.资料与方法 回顾性分析45例AIDS合并PM感染患者的胸部X线和CT表现,并与病灶的吸收时间、体内PM的转阴时间及患者预后情况进行对照分析.结果 (1)AIDS合并PM感染的胸部影像学表现复杂多样:①斑片或大片状渗出病变为主型13例;②结节病变为主型14例;③双肺弥漫粟粒病变为主型4例;④肿块病变为主型4例;⑤双肺肺气囊为主型2例;⑥双肺弥漫磨玻璃样改变为主型3例;⑦双肺弥漫网织状纹理增粗并淋巴结增大2例,仅见纵隔淋巴结增大2例,仅见胸腔少量积液1例.(2)影像学表现与转归:①患者体内PM转阴时间早于胸部病变吸收时间;②粟粒病变为主型患者体内PM转阴的时间长于渗出病变、肿块病变为主型者;③肿块病变为主型患者病变吸收时间长于渗出病变、结节病变及弥漫粟粒病变为主型者;④双肺弥漫磨玻璃样改变和网织状纹理增粗并淋巴结增大患者死亡率最高,其次为肺部结节型患者,再次为渗出病变为主型患者.上述差异在统计学上有显著性意义(P<0.05).结论 AIDS合并PM感染的胸部影像学表现多样,X线平片和CT检查能反映AIDS合并PM感染的病变转归情况;根据不同的影像学表现选择复查时间,有利于指导临床治疗.     

HIV感染者和AIDS患者并发肺结核的CT表现

目的 探讨HIV感染者和艾滋病患者(HIV/AIDS)并发肺结核的CT表现特征.方法回顾性分析48例HIV/AIDS并发肺结核的CT表现.结果 HIV/AIDS患者肺结核的CT表现为:继发型肺结核19例(39.6%),病变形态以斑片状阴影为主,10例可见融合成大片的实变影;血行播散型肺结核17例(35.4%),其中急性粟粒型肺结核7例,表现为大小、分布均匀的粟粒影,而亚急性血行播散型10例,表现为大小、分布不均匀的粟粒、小结节影;多种征象混合表现10例(20.8%),表现为双肺斑片状渗出病灶与弥漫分布的粟粒、小结节灶相混杂.纵隔淋巴结肿大36例(75.0%),胸腔积液13例(27.1%),心包积液10例(20.8%).结论 HIV/AIDS并发肺结核的CT特征为局灶性肺实质病变较少而弥漫性的病变较多.     

艾滋病合并肺结核26例临床分析

目的:分析艾滋病合并肺结核患者流行病学及临床特点。方法:回顾分析26例艾滋病合并肺结核患者临床表现、辅助检查及诊断治疗情况。结果:26例患者中青壮年占88.5%,HIV感染途径主要是血液接触传播(42.3%)、性接触传播(53.8%)和静脉吸毒传播(23.1%),临床表现有连续发热、咳嗽、腹泻一个月以上的特点,PPD试验阴性率76.9%,全身淋巴结肿大69.2%,X线表现继发型肺结核73.1%,同时罹患肺外淋巴结核51.9%,一年内病死率65.4%。结论:艾滋病合并肺结核患者PPD试验阴性率高,X线表现不典型,诊断困难,病情复杂,疗效差,病死率高。     

艾滋病合并肺结核的CT表现与CD4T淋巴细胞的关系

目的:探讨艾滋病合并肺结核的CT表现与CD4T淋巴细胞的关系。材料和方法:回顾性分析临床确诊的23例艾滋病合并肺结核CT扫描资料,并定期CT复查以及CD4T淋巴细胞的检测,观察其HARRT及抗结核治疗后肺部病灶的动态变化。结果:病灶分布两个肺叶以上10例、中叶(舌叶)及下叶17例。大片状融合实变影9例、斑片状影6例、双肺弥漫性结节影5例和空洞影2例。纵隔及肺门淋巴结肿大15例,主要分布2R、4R区。病灶恶化进展患12例,CD4T淋巴细胞持续降低或衰竭;病灶吸收或缩小11例,早期CD4不同程度降低,3个月后CD4均有不同程度升高。结论:CT扫描能有效显示病变的各种征象,有利于艾滋病合并肺结核的诊断。CD4T淋巴细胞的量值是影响肺结核病变的动态变化及预后的重要因素。     

Pulmonary tuberculosis in AIDS patients: transient chest radiographic worsening after initiation of antiretroviral therapy

OBJECTIVE: Immune function and inflammatory responses often increase in AIDS patients who receive antiretroviral therapy. We evaluated the occurrence and nature of transient worsening on chest radiographs in AIDS patients with tuberculosis after initiation of antiretroviral therapy and compared these findings with chest radiographs of patients undergoing antituberculous therapy alone. MATERIALS AND METHODS: A retrospective review of sequential chest radiographs was performed of 87 patients undergoing therapy for pulmonary tuberculosis: AIDS patients receiving antiretroviral therapy (n = 31), HIV-positive patients not receiving antiretroviral therapy (n = 26), and HIV-negative patients (n = 30). Pulmonary consolidations, thoracic lymphadenopathy, and pleural effusions were evaluated for worsening, stability, or improvement. Patients with concurrent pulmonary infections were excluded. RESULTS: Transient worsening on radiography was observed in 14 (45%) of 31 AIDS patients receiving antiretroviral therapy, including seven patients (23%) who showed severe worsening. Of 56 patients in the other two groups, 11 (20%) showed worsening (p = 0.023), two of whom showed severe worsening (p = 0.009). Worsening was first noted between 1 and 5 weeks after initiation of antiretroviral therapy, with improvement occurring between 2 weeks and 3 months later. Four patients with severe worsening converted their tuberculin purified protein derivative responses from anergic to positive after antiretroviral treatment. CONCLUSION: Transient worsening is frequently seen on chest radiography in AIDS patients with tuberculosis who subsequently undergo antiretroviral therapy. This phenomenon may be related to improved immune function.     

艾滋病并发肺结核的胸部改变(附29例X线分析)

作者在坦桑尼亚工作期间,收集到一组(29例)非洲成人艾滋病并发肺结核病例。就其胸部X线表现进行了分析,较突出的表现为:(1)病变分布广泛,多同时累及两侧肺,无一例病变仅局限于上肺野。(2)合并肺门及纵隔淋巴结肿大者16例,出现率为55％。(3)17例(58.6％)出现空洞。(4)5例有纤维条索影,无一例出现钙化。艾滋病并发肺结核的确诊需靠HIV血清抗体试验及痰细菌学检查。