1 / 20

Approach to Pulmonary Manifestations of HIV/AIDS

Approach to Pulmonary Manifestations of HIV/AIDS. Dr. Flip Otto Dept. of Radiology Universitas Academic Hospital. Pulmonary Manifestations of HIV/AIDS. Opportunistic infection Drug reactions Immune restoration syndrome Lymphoproliferative disorders AIDS related malignancy

azure
Télécharger la présentation

Approach to Pulmonary Manifestations of HIV/AIDS

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Approach to Pulmonary Manifestations of HIV/AIDS Dr. Flip Otto Dept. of Radiology Universitas Academic Hospital

  2. Pulmonary Manifestations of HIV/AIDS • Opportunistic infection • Drug reactions • Immune restoration syndrome • Lymphoproliferative disorders • AIDS related malignancy • Non-specific interstitial pneumonitis • HIV related pulmonary hypertension • Bronchiolitis obliterans • Emphysema and bronchiectasis

  3. Infective pulmonary conditions in HIV/AIDS • Bacterial • PJP • TB • MAI • Fungal: Cryptococcus; Aspergillosis etc. • Viral: CMV

  4. Non-infective pulmonary conditions in HIV/AIDS • Kaposi’s sarcoma • Lymphoma • Lung carcinoma • Lymphocytic interstitial pneumonitis • Emphysema • Cardiovascular complications

  5. Prevalence of HIV/AIDS associated pulmonary conditions in relation to CD4 count • CD4>400: Increased risk for - Bacterial infection - Mycobacterium tuberculosis • CD4 200-400: Increased risk for - Recurrent bacterial infections - Mycobacterium tuberculosis - Lymphoma and lymphoproliferative disorders • CD4<200: Increased risk for - PJP - Disseminated Mycobacterium tuberculosis • CD4<100: Increased risk for - PJP - Atypical Mycobacterium tuberculosis - CMV - Kaposi’s sarcoma - Lymphoma

  6. Radiographic patterns • Nodules • Cavities • Adenopathy • Focal consolidation • Pleural effusion

  7. Nodules • Common • Size: - <1cm (random or centrilobular) more likely due to infection - >1cm more likely neoplastic • Miliary nodularity typically fungal or TB, rarely seen in PJP • KS peribronchovascular vs lymphoma and lung cancer peripheral

  8. Miliary TB

  9. CMV pneumonia

  10. Cavities • Mostly infective • 85% polymicrobial, majority bacterial: mixed infections often involving Staph and Pseudomonas • Remainder include: TB, PJP, fungi, CMV

  11. Necrotizing cavitating pneumonia

  12. Pneumocystis pneumonia

  13. Adenopathy • Mostly due to infection • TB most common cause of isolated adenopathy, can be seen with Cryptococcus. Associated with low attenuation with ring enhancement. • Lung cancer included in differential diagnosis • Calcified adenopathy: TB, fungus, described in PJP • Hyperattenuating adenopathy in KS due to vascular enhancement

  14. TB lymphadenopathy

  15. Focal consolidation • Mostly due to infection • Bacterial pneumonia most common cause in AIDS, but Pneumocystis most common individual pathogen (rarely segmental pattern) • TB, MAI, fungi (Cryptococcus), mixed infections and occsionally neoplasms (lymphoma and KS)

  16. Primary TB

  17. Pleural effusion • Majority small, equal incidence in infection and malignancy • Infective causes (bacterial and TB) tend to be unilateral • KS associated tend to be bilateral • Non-AIDS causes eg PE and organ failure should also be considered

  18. Kaposi sarcoma

  19. Approach • Combine: - Risk factors - Level of immunocompromise - prophylactic Rx - clinical presentation - radiographic pattern • CD4 count most important determinant for assessing relative likelyhood • Chest radiography 1st line imaging • CT and HRCT 2nd line when CXR findings equivocal or non-specific

  20. References • Aviram G, Fishman JE, Boiselle PM. Thoracic manifestations of AIDS. Applied Radiology 2003;Vol 32:8 • Allen CM, Al-Jahdali HH, Irion KL, Ghamen SA, Gouda A, Khan AN. Imaging lung manifestations of HIV/AIDS. Ann Thorac Med 2010;5:201-16

More Related