Presentation
Known HIV, recently off retroviral medication with a 3 week history of SOB.
Patient Data
Diffuse or perihilar fine reticular and ill-defined ground glass opacities.
CT findings include scattered or diffuse ground glass opacities, consolidation and thickening of interlobular septa. Ground glass opacities may predominate in the early stages of the disease, with linear opacities in the more chronic stage.
Case Discussion
CXR is normal at presentation in up to 6% of symptomatic patients. Hilar or mediastinal lymphadenopathy is rare, as is pleural fluid in the absence of extrapulmonary pneumocystosis.
In practice, the disease affects both airways and interstitium. Normal CT is good evidence that PCP is not the cause of symptoms.
One third of patients with PCP develop pneumatocoeles, with predilection for upper lobes, especially in patients treated with aerosolized pentamidine. Spontaneous pneumothorax is a complication.
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