Imaging Approach to Pulmonary Infections in the Immunocompromised Patient

Abstract

Pulmonary infections are the major cause of morbidity and mortality in immunocompromised patients and almost one-third of intensive care unit patients with pulmonary infections belong to the immunocompromised category. Multiple organisms may simultaneously infect an immunocompromised patient and the overwhelming burden of mixed infections further predisposes critically ill patients to acute hypoxemic respiratory failure. Notwithstanding that lung ultrasound is coming into vogue, the primary imaging investigation is a chest radiograph, followed by thoracic CT scan. This review based on our experience at tertiary care teaching hospitals provides insights into the spectrum of imaging features of various pulmonary infections occurring in immunocompromised patients. This review is unique as, firstly, the imaging spectrum described by us is categorized on basis of the etiological infective agent, comprehensively and emphatically correlated with the clinical setting of the patient. Secondly, a characteristic imaging pattern is emphasized in the clinical setting-imaging-pattern conglomerate, to highlight the most likely diagnosis possible in such a combination. Thirdly, the simulating conditions for a relevant differential diagnosis are discussed in each section. Fourthly, not only are the specific diagnostic and tissue sampling techniques for confirmation of the suspected etiological agent described, but the recommended pharmaco-therapeutic agents are also enumerated, so as to provide a more robust insight to the radiologist. Last but not the least, we summarize and conclude with a diagnostic algorithm, derived by us from the characteristic illustrative cases. The proposed algorithm, illustrated as a flowchart, emphasizes a diagnostic imaging approach comprising: correlation of the imaging pattern with clinical setting and with associated abnormalities in the thorax and in other organs/systems, which is comprehensively analyzed in arriving at the most likely diagnosis. Since a rapid evaluation and emergent management of such patients is of pressing concern not only to the radiologist, but also for the general physicians, pulmonologists, critical care specialists, oncologists and transplant surgery teams, we believe our review is very informative to a wide spectrum reader audience.

Pulmonary Tuberculosis in Immunocompromised Patients: A Review

“…Pleural effusion with pleural enhancement can also be seen in infections like S. aureus and Nocardia . 40 41 Differentials based on predominant imaging patterns are discussed in Table 1 .…”

Hypodense Sign in Lungs on CT in Immunocompromised Patient

“…We read with interest the article entitled “Imaging Approach to Pulmonary Infections in the Immunocompromised Patient” by Grover et al 1 We would like to add a “hypodense sign” (HyS) to the list of radiological findings described by the authors. The HyS was described by Horger et al as 2 the presence of a central area of hypodensity seen on narrow window settings (width: 110–140 Hounsfield Units [HU]; level: 15–40 HU).…”