Paciente VIH con infección por Pneumocystis jirovecii: hallazgos en tomografía computarizada de alta resolución / HIV patient with Pneumocystis jiroveci infection: findings in high resolution tomography (HRCT)

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[A Case of Pneumocystis Pneumonia Developed during Chemotherapy for Sigmoid Colon Cancer].

A 69-year-old man with multiple liver metastases from sigmoid colon cancer received mFOLFOX6 plus cetuximab(Cmab) chemotherapy. A partial response was observed; hence, we performed an extended left hepatectomy, 3 partial liver resections, and a sigmoidectomy. After 4 courses of CapeOX, a recurrent lesion occurred between S8 and S7 of the liver, and we changed the regimen to FOLFIRI plus bevacizumab(BV). Three months later, he had Grade 3 febrile neutropenia and CT scan findings showed ground glass opacity in the superior lobes of both lungs. We diagnosed pneumocystis pneumonia(PCP)and administered steroids and trimethoprim/sulfamethoxazole. The signs of PCP thus improved. PCP during chemotherapy for gastrointestinal cancer is rarely reported, but recently it has increased.

Cryptogenic organizing pneumonia associated with Pneumocystis carinii infection and sirolimus therapy in a renal transplant patient.

We present the case of a renal transplant patient on sirolimus (rapamycin) therapy who developed cryptogenic organizing pneumonia in association with Pneumocystis carinii infection. To our knowledge, such a case has not been previously reported.

Concurrent focal hepatic and splenic lesions: a pictorial guide to differential diagnosis.

Although medical literature and differential diagnoses discussions tend to be organ specific, systemic diseases more commonly manifest with multi-organ involvement. Detection of dual organ involvement combined with clinical history narrows the differential to provide a more specific diagnosis. Two organs closely linked are the liver and the spleen. Many processes affect both of these organs through their common denominator, the reticuloendothelial system (RES). This pictorial essay reviews the wide spectrum of benign and malignant pathologies to be considered when computed tomography (CT) demonstrates concurrent focal disease in the liver and spleen.

Pneumocystis carinii infection presenting as an intra-abdominal cystic mass in a child with acquired immunodeficiency syndrome.

We describe the case of a pediatric patient with acquired immunodeficiency syndrome (AIDS) with an unusual large, fluid-filled intra-abdominal cystic lesion in which Pneumocystis carinii trophozoites were identified. Extrapulmonary P. carinii infection should be considered in the differential diagnosis of an intra-abdominal cystic mass in a child with AIDS.

Selective assessment of single-lung graft function with 133Xe radiospirometry in acute rejection and infection.

In single-lung transplant recipients, the usefulness of spirometric indexes in detecting acute events involving the lung graft is limited due to the bias caused by the native lung. Selective functional monitoring is needed for the proper evaluation of complications after transplantation, but thus far, to our knowledge, no clinically feasible methods for selective graft-function assessment have been presented. In ten single-lung recipients, of whom six had a parenchymal lung disease and four had pulmonary hypertension, the relative ventilation (Vtx), perfusion (Qtx), and ventilation/perfusion ratio of the transplanted lung (V/Qtx) were determined with multidetector 133Xe radiospirometry. Additionally, the fractions of FEV1, FVC, and diffusing capacity for carbon monoxide (Dco) of the transplant (FEV1tx, FVCtx, Dcotx, respectively) were determined by using corresponding radiospirometric parameters for the calculation of their distribution between the lungs. The analysis included seven episodes of acute rejection and nine episodes of infection. The Qtx decreased during acute rejection but did not change during infection (p=0.001). Compared with the figures during infection, the V/Qtx increased during acute rejection significantly (p<0.05) in patients with underlying fibrosis or emphysema, but not in those with pulmonary hypertension. In detection of acute events, the sensitivity of the selective parameters, ie, FEV1tx (86%) and FVCtx (73%), was higher than that of the sum-function parameters, FEV1 (66%) and FVC (40%). Moreover, the sensitivity of Dcotx (80%) was higher than that of Dco (60%) in detecting acute rejection. The findings indicate that, in single-lung recipients with a parenchymal lung disease, the assessment of Qtx, V/Qtx, and Dcotx with a radioactive tracer can help to distinguish acute rejection from infection. The graft-selective parameters, ie, FEV1tx, FVCtx, and Dcotx, tended to be more sensitive than the corresponding sum-function parameters in detecting acute events, thus providing a more accurate functional profile of the single-lung graft.

HIV infection: analysis in 259 consecutive patients with abnormal abdominal CT findings.

PURPOSE: To evaluate abdominal computed tomographic (CT) findings in patients with human immunodeficiency virus (HIV) infection. MATERIALS AND METHODS: CT scans with abnormal findings in 259 patients (247 men, 12 women; age range, 21-60 years) with HIV infection were analyzed. Diagnoses were mycobacterial infection (n = 87), lymphoproliferative disease (n = 63), Kaposi sarcoma (n = 17), fungal infection (n = 17), hepatocellular disease (n = 13), Pneumocystis carinii infection (n = 8), other disorders (n = 39), or unknown (n = 30). RESULTS: Abnormal findings included lymph-node enlargement (n = 159), hepatomegaly (n = 100), splenomegaly (n = 62), gastrointestinal mass or wall thickening (n = 61), and low-attenuation lesions in the liver (n = 50) or spleen (n = 55). Diagnoses thought to account for CT findings were made (n = 229) or suspected (n = 18) in 247 (95%) of the 259 patients. CONCLUSION: In most patients with HIV infection, abnormal abdominal CT findings are due to a second disease. Even relatively nonspecific findings should not be ascribed to HIV infection and should prompt a search for an opportunistic infection or neoplasm.

Microabscesses of the liver and spleen in AIDS: detection with 5-MHz sonography.

PURPOSE: To determine whether sonograms of the liver and spleen, obtained with 5-MHz linear-array transducers, aid in detection of hepatosplenic microabscesses in patients with acquired immunodeficiency syndrome (AIDS). MATERIALS AND METHODS: Abdominal sonographic examinations (n = 111) were performed in 102 consecutive patients with AIDS. A 3.5-MHz sector transducer was used in each study, with additional images of the hepatic and splenic parenchyma obtained with a 5-MHz linear-array transducer. Each study was reviewed without benefit of the 5-MHz images, and categories of the hepatic and splenic parenchyma were as follows: 1, lesions definitely present; 2, lesions possibly present; and 3, lesions absent. The 5-MHz images were subsequently reviewed, and studies were recategorized. Findings were correlated with results of pathologic examination. RESULTS: The 5-MHz scans enabled identification of focal hepatic or splenic lesions in 14 of 96 studies placed in category 2 or 3 on the basis of the 3.5-MHz sector scans. CONCLUSION: In patients with AIDS, 5-MHz sonograms of the liver and spleen enable detection of microabscesses not confidently identified on 3.5-MHz scans.

Mediastinal and hilar lymphadenopathy due to Pneumocystis carinii infection in AIDS patients: CT features.

OBJECTIVE: Extrapulmonary involvement by Pneumocystis carinii (PC) in acquired immunodeficiency syndrome (AIDS) patients is uncommon. Our purpose is to describe three AIDS patients with low cluster differentiation cell (CD4) counts, who were receiving aerosol pentamidine prophylaxis, and who had large noncalcified hilar and mediastinal lymphadenopathy. MATERIALS AND METHODS: Chest radiography, CT, and clinical and laboratory records of three AIDS patients who had radiographic evidence of mediastinal and hilar lymphadenopathy were retrospectively reviewed. RESULTS: Symptoms were quite similar in all patients: weight loss, fever, cough, and mild dyspnea. Mediastinal and hilar widening was noticed on chest radiography. Contrast-enhanced chest CT revealed multiple noncalcified lymphadenopathy with supracarinal predominance in all cases. Mediastinoscopy with mediastinal and hilar lymph nodes sampling was performed in all patients. Histologic examination of the biopsy specimens demonstrated a necrotic foamy tissue without any calcification, and silver stain coloration showed abundant PC organisms in each case. CONCLUSION: In AIDS patients, PC infection should be considered as a possible cause of noncalcified hilar and mediastinal lymphadenopathy along with such possibilities as atypical infections and neoplasms, especially in severely immunocompromised hosts (low CD4) with aerosol pentamidine prophylaxis.

Imaging of the spleen: CT with supplemental MR examination.

Splenic lesions tend to be small or infiltrating and vary in size and configuration, making detection difficult, particularly without use of an organ-specific contrast agent. The authors present a series of selected cases to show the value of computed tomography (CT) and magnetic resonance (MR) imaging in depiction of splenic disease. Six major categories are presented: (a) inflammatory disease, (b) splenic cysts, (c) infarction, (d) nonneoplastic and noninfectious diffuse splenic disease, (e) benign tumors, and (f) malignant tumors. CT attenuation of splenic tissue is homogeneous, typically measuring 40-60 HU on non-contrast material-enhanced scans. Splenic attenuation is normally 5-10 HU less than that of liver, a standard of reference used in evaluation of either hepatic or splenic disease. On T1-weighted MR images, the normal signal intensity of the spleen is less than that of hepatic tissue and slightly greater than that of muscle. On T2-weighted images, the spleen shows higher signal intensity, appearing brighter than the liver. CT is currently the choice for evaluation of the spleen; however, MR imaging may be increasingly used as newer pulse sequences and organ-specific contrast agents are developed.

Renal manifestations of AIDS.

The kidneys in patients with acquired immunodeficiency syndrome (AIDS) are subject to a variety of insults. Renal manifestations can be seen with imaging studies of AIDS patients. Computed tomographic (CT) and ultrasound (US) scans of 64 patients with AIDS and renal dysfunction were retrospectively reviewed and compared with clinical, laboratory, and, when available, biopsy results. Imaging abnormalities included increased cortical echogenicity, nephromegaly, pyelonephritis, lobar nephronia, focal masses caused by abscess and lymphoma, parenchymal calcification, hydronephrosis, and infarct. Generally, patients with AIDS as a result of intravenous drug abuse and those with multiple risk factors were more likely to have abnormalities demonstrated at imaging as well as poorer prognosis than were patients in the homosexual transmission group in this series. Although US should be the screening study used in patients with AIDS and suspected renal dysfunction, CT and magnetic resonance imaging may be necessary to identify focal infectious, ischemic, and neoplastic processes.