ABSTRACT
Knowledge of common and uncommon thoracic pathologic conditions in children with acquired immunodeficiency syndrome (AIDS) can expedite disease management. Chest radiography, computed tomography (CT), and magnetic resonance (MR) imaging are useful in cases involving possible complications of thoracic AIDS. Lymphocytic interstitial pneumonitis (LIP) is generally seen on plain radiographs and CT scans as a diffuse, symmetric, reticulonodular or nodular pattern, occasionally associated with mediastinal or hilar adenopathy. Chronic consolidations and bronchiectasis may be observed in pediatric AIDS patients with no evidence of previous LIP. Bacterial pneumonia, a frequent initial manifestation of AIDS, appears as lobar or segmental consolidations on radiographs. Radiographic findings of Pneumocystis carinii pneumonia, the most common infection, include rapidly progressive increased air-space opacity with air bronchograms. Lymphoma often appears as a mediastinal or hilar mass, often without involvement of the lung parenchyma. Thoracic smooth muscle tumors have also been observed in children with AIDS. Multilocular thymic cysts have low attenuation on CT scans and increased signal intensity on T2-weighted MR images. Most pediatric AIDS patients with cardiac disease have cardiomegaly, often associated with pulmonary edema, at chest radiography. An esophagogram may show ulceration, plaque formation, mucosal edema, and dysmotility in patients with candidal esophagitis.
Subject(s)
Acquired Immunodeficiency Syndrome/complications , Thoracic Diseases/complications , AIDS-Related Opportunistic Infections/diagnosis , AIDS-Related Opportunistic Infections/diagnostic imaging , Bronchiectasis/complications , Bronchiectasis/diagnosis , Bronchiectasis/diagnostic imaging , Child , Child, Preschool , Esophageal Diseases/complications , Esophageal Diseases/diagnosis , Esophageal Diseases/diagnostic imaging , Female , Heart Diseases/complications , Heart Diseases/diagnosis , Heart Diseases/diagnostic imaging , Humans , Infant , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/diagnostic imaging , Magnetic Resonance Imaging , Male , Mediastinal Cyst/complications , Mediastinal Cyst/diagnosis , Mediastinal Cyst/diagnostic imaging , Radiography, Thoracic , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/diagnostic imaging , Thoracic Diseases/diagnosis , Thoracic Diseases/diagnostic imaging , Thoracic Neoplasms/complications , Thoracic Neoplasms/diagnosis , Thoracic Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The authors describe a case of squamous cell carcinoma of the esophagus that was initially diagnosed as hydropneumopericardium at radiography. The patient subsequently underwent computed tomography (CT) and esophagography. CT revealed pneumopericardium, pericardial thickening, a mass in the esophagus, and bilateral effusion. Esophagography demonstrated perforation of the mid-thoracic esophagus and marked irregularity of the esophageal mucosa. To the authors' knowledge, this is the only reported instance of esophageal carcinoma initially diagnosed as hydropneumopericardium. CT can be used as a primary method to investigate spontaneous pneumopericardium.
