CTICasesPneumocystis jirovecii Pneumonia (PJP) with Upper Lobe Predominance
Imaging findings
Chest radiograph in a leukemia patient (ALL with relapse) shows normal findings with a barely visible smudge. Three days later, the radiograph shows diffuse bilateral ground-glass opacity with upper lobe concentration. CT performed the following day shows confluent bilateral ground-glass opacity with striking upper lobe and anterior predominance on the sagittal view, with the most severe involvement seeming to avoid the very anterior and very posterior edges of the upper lobes, centered in the mid-upper lung. Subsequent bronchoscopy confirmed Pneumocystis jirovecii pneumonia (PJP).
Key takeaways
PJP can have upper lobe predominance even in patients who are not receiving inhaled pentamidine prophylaxis; this distribution precedes the HIV/AIDS era and is a property of the organism itself rather than a consequence of prophylaxis. PJP can progress from a nearly normal chest radiograph to florid bilateral lung disease in as little as 2 days in chemotherapy patients with rapid T-cell depletion, distinguishing it from the more subacute presentation in HIV patients with slow CD4 count decline. Cystic spaces in the lung are more characteristically associated with HIV-positive PJP than with non-HIV PJP, likely due to the more prolonged course in HIV patients. Upper lung PJP without pentamidine should not be dismissed.
AI-assisted summary — may contain errors. Verify against the source video. Learn more
More from this webinar
- Fibrosing Mediastinitis from Histoplasmosis with Cor PulmonaleInfection
- Port-A-Cath Lead Fracture and Intracardiac MigrationIatrogenic
- Cryptococcus gattii Presenting as Solitary Lung Nodule with LeptomeningitisInfection
- Twiddler Syndrome — ICD Lead Coiling and Proximal MigrationIatrogenic
- Large Cystic Mediastinal TeratomaNeoplastic
- Cystic Lung Disease Mimicking UIP — Possible Airspace Enlargement with Fibrosis (AEF)ILD
- Unexplained Symmetric Peribronchial Cystic Lung Disease in a Young West African WomanILD
- Unusual Bilateral Pleural Calcifications in a Young Man — Milk of CalciumOther
See all cases from September 1, 2017 →