Pneumocystis jiroveci pneumonia

Case contributed by Henry Knipe
Diagnosis certain

Presentation

Flu-like illness. Rash.

Patient Data

Age: 70 years
Gender: Male
x-ray
Frontal
Lateral
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Diffuse interstitial opacities are seen throughout both lungs with a mid-to-upper zone predominance. 

This study is a stack
Axial lung
window
This study is a stack
Axial lung
window MIP
This study is a stack
Axial C+
delayed
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Info

There are numerous small ill-defined lung nodules and groundglass opacities, particularly affecting the upper lobes. Atelectasis / fibrosis within the middle lobe medially.

The mediastinum appears normal. No pericardial effusion. 

The patient proceeded to bronchoscopy and bronchoalveolar lavage:

Pneumocystis jiroveci DNA by PCR: Detected

Case Discussion

Pneumocysitis pneumonia is an atypical infection which typically has perihilar ground glass opacity. The nodules in this case are somewhat atypical and a differential diagnosis of tuberculosis was given on imaging appearances. 

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