Lymphocytic interstitial pneumonitis

Case contributed by Dr Yair Glick

Presentation

Fever in HIV patient.

Patient Data

Age: 40 years
Gender: Male

Pulmonary trunk is dilated (35 mm) and so are main pulmonary arteries.
Enlarged left supraclavicular lymph nodes.
Pronounced mediastinal lymphadenopathy and mild bilateral hilar lymphadenopathy, more prominent on the left.
Emphysematous lungs.
Numerous thin-walled air-filled cysts scattered throughout the lungs, ranging from several mm to approximately 2 cm in size.
Subsegmental bibasal atelectasis.

Contrast blush in hepatic segment 8 - either a vascular shunt or a flash-filling hemangioma.
Calcific foci in spleen, most probably calcified granulomas.

Case Discussion

Given a history of HIV and the appearance of pulmonary cysts of varying sizes, the most probable diagnosis is lymphocytic interstitial pneumonitis (LIP).

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