X-ray: Pneumocystis Pneumonia

Imaging of the weekDr.Anirudh J Shetty

PROF.DR.DHANDAPANI’S UNIT

34 yr old unmarried male ,c/o fever without chills –2 days; breathlessness & hemoptysis-1 day;h/o non productive cough +No h/o haematuriaNo h/o chest pain /PND /orthopneaNot a known DM/HT/TB/IHD/BA/ pt.

O/E emaciated,thin ,dyspneic,tachypneic vitals-BP -110/80 mmHg CVS-S1 ,S2 heard RS- bil.BB + in

infrascapular,mammary ,inframammary and infraaxillary areas bil.creps.+

other systems- NAD

SUMMARY; -CHEST X RAY PA VIEW -ADEQUATELY PENETRATED -INSPIRATORY FILM -PROPERLY CENTRED -TRACHEA IN THE MIDLINE -SOFT TISSUES & BONE NORMAL -HEART SHADOWS NORMAL

NON HOMOGENOUS OPACITIES SEEN BILATERALLY IN THE MID AND LOWER ZONES

MORE ON THE LEFT SIDE

DIFFERENTIAL DIAGNOSIS; ACUTE ALVEOLAR LUNG DISEASE

“HEAP” Hemorrhage -Wegener granulomatosis

Systemic lupus erythematosus Goodpasture syndrome Other vasculitides (e.g., polyarteritis

nodosa, Henoch-Schönlein purpura)

Edema Alveolar proteinosis/Aspiration Pneumonia (includes infectious, organizing, and eosinophilic pneumonias)

Pneumocystis PNEUMONIA RADIOLOGY; - bilateral diffuse opacities, perihilar

initially,with a lower zone predominance”ground glass “opacities

-later air space consolidation pattern

ATYPICAL PRESENTATIONS -solitary/multiple ;solid /cavitory nodular opacities -cystic lung disease -enlarged noncalcified/calcifiedhilar/mediastinal nodes -pleural effusion -air filled cysts/pneumatoceles causing pneumothorax

CLINICAL FEATURES; non specific

dyspnea,dry cough

minimal signs –few crackles,wheeze

unusual-asthma,hemoptysis,HPOA

PCP related pneumothorax-sudden dyspnea in AIDS patients

EXTRAPULMONARY PCP; Virtually every organ system can be

affected heart thyroid bonemarrow brain git skin other manifestations include otitis media

and externa, sinusitis n splenomegaly

Thank u