Diffuse air-space disease bilateraly
No pleural effusions
Stable cardiomegaly
Oval lucency in peripheral left upper lung
Patients with AIDS usually have an insidious onset over several weeks, whereas other immunocompromised patients typically have a rapid onset. Symptoms are severe and include dsypnea, cyanosis and an increased A-a oxygen gradient.
Diagnosis is most commonly made with bronchoalveolar lavage although direct immunofluorescent antibodies are an alternative.
Treatment and prophylaxis are typically with Bactrim.
Radiographic presentation consists of a perihilar and basilar predominant reticular pattern which may be very subtle at the time of initial presentation. As the disease progresses ground glass opacities develop and eventually air-space disease which may become diffuse and coalescent. Other common findings include atelectasis, hyperaeration and pneumothorax. Pleural effusions and adenopathy are uncommon. Predominantly upper lobe involvement was previously seen in patients receiving prophylaxis with aerosolized pentamidine but as this practice wanes in popularity this pattern is becoming less common. Patients may also develop thin-walled cysts and bullae. When wide-spread dissemination of the organism has occurred calcified lymph nodes may be seen throughout the body.