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

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Presentation on theme: "Approach to Pulmonary Manifestations of HIV/AIDS Dr. Flip Otto Dept. of Radiology Universitas Academic Hospital."— 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 CD : 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 1 st line imaging CT and HRCT 2 nd 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


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