CTICasesUpper-Lobe Predominant Pneumocystis jirovecii Pneumonia
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Imaging findings
Chest radiograph and CT show bilateral, ground-glass opacities with a striking, atypical upper-lung predominant distribution and early cyst formation. Bronchoalveolar lavage PCR confirmed Pneumocystis jirovecii.
Key takeaways
While Pneumocystis jirovecii pneumonia typically presents with diffuse, symmetric ground-glass opacities, it can occasionally manifest with a striking upper-lobe predominance, mimicking tuberculosis or histoplasmosis, especially in severely immunocompromised patients with very low CD4 counts.
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