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Intrathoracic Complications of HIV

Intrathoracic Complications of HIV. Jay Mizzell 2.2.06. Roadmap. Infectious manifestations PCP TB Bacterial pneumonia Noninfectious manifestations Kaposi sarcoma Others . Incidence of AIDS defining OI in men v women 1996-1998. Pneumocystis carinii pneumonia.

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Intrathoracic Complications of HIV

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  1. Intrathoracic Complications of HIV Jay Mizzell 2.2.06

  2. Roadmap • Infectious manifestations • PCP • TB • Bacterial pneumonia • Noninfectious manifestations • Kaposi sarcoma • Others

  3. Incidence of AIDS defining OI in men v women 1996-1998

  4. Pneumocystis carinii pneumonia • Most common opportunistic infection in US • CD4 counts <200 • Fever, dyspnea, nonproductive cough

  5. PCP Radiographic Features • Classic findings • Interstitial or alveolar infiltrates • Diffuse • Bilateral • Atypical or normal findings are common

  6. Typical PCP

  7. Typical PCP

  8. Typical PCP

  9. Tuberculosis • 4% of all US AIDS cases • More common worldwide • Most common manifestation of HIV • Most common cause of death with AIDS

  10. TB Radiographic Features • Infection early in HIV course (CD4 > 400) • 1° TB • Post 1° TB • Infection late in HIV course (CD4 < 200) • Nodular interstitial pattern • Diffuse, bilateral, coarse • Hilar adenopathy • No cavitation

  11. 1° TB

  12. 1° TB

  13. Ranke Complex

  14. Post 1° TB

  15. Post 1° TB

  16. Atypical TB

  17. Atypical TB

  18. Bacterial Pneumonia • More common than PCP in US • Predilection for IVDU • Encapsulated bacteria • Esp S. pneumoniae and H. influenzae • Radiographically indistinguishable

  19. Kaposi Sarcoma • Caused by HHV8 • Almost exclusively in MSM • Appears at lower CD4 counts • Mucocutaneous concurrent with pulmonary manifestations

  20. KS Radiographic Features • Bilateral middle-lower lung opacities • Nodular, ill-defined • Perihilar distribution • Intrathoracic adenopathy • Bronchial wall thickening • Pleural fluid

  21. Kaposi Sarcoma

  22. Kaposi Sarcoma

  23. Other Noninfectious Findings • Non-Hodgkin lymphoma • Lymphocytic Interstitial Pneumonitis • Nonspecific Interstitial Pneumonitis

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