Atypical roentgenographic manifestations of Pneumocystis carinii pneumonia
C. A. Kennedy and M. B. Goetz
Department of Medicine, Sepulveda Veterans Affairs Medical Center, CA 91343.
Although Pneumocystis carinii pneumonia (PCP) usually presents with
bilateral interstitial pulmonary infiltrates, many other roentgenographic
presentations occur in human immunodeficiency virus-infected patients. To
clarify the determinants of atypical presentations of PCP, we evaluated 65
English-language reports that related the roentgenographic manifestations
of consecutive cases of PCP. The incidence of PCP-associated upper lobe
disease, cysts, and spontaneous pneumothoraxes was increased in human
immunodeficiency virus-infected patients receiving aerosolized pentamidine
prophylaxis. Normal chest roentgenograms were more common and nodular
lesions were less common in human immunodeficiency virus-infected patients
than in uninfected patients. However, the roentgenographic manifestations
of PCP could not be specifically predicted by a patient's underlying
disease. Neither zidovudine therapy nor intravenous drug use apparently
affected the roentgenographic presentation of PCP. Unusual pathologic
responses to PCP, including granuloma formation, vascular invasion, and
microscopic foci of calcification, were present in all patient groups.
