CTICasesDiffuse Cystic Lung Disease in HIV (Lymphocytic Interstitial Pneumonia vs. Post-Pneumocystis Cysts)
Imaging findings
A man in his 50s with longstanding HIV had a clear chest radiograph but numerous discrete, punched-out, thin-walled cysts scattered throughout both lungs on CT, with a lower-lung-predominant distribution atypical for the more classic upper-lung, peripheral distribution of residual Pneumocystis pneumonia cysts.
Key takeaways
Diffuse cystic lung disease in a patient with HIV has a differential that includes residual cysts from prior Pneumocystis pneumonia and lymphocytic interstitial pneumonia (LIP), which characteristically shows a perivascular cyst distribution and is more common in children but can rarely occur in HIV-infected adults. A history of an indolent, non-nodal lymphoma (for example, a cutaneous lymphoma) should also be considered in an HIV patient with cystic lung disease, since such a history can be easy to overlook if the patient was managed outside the usual oncology channels.
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