Lymphocytic interstitial pneumonia in children with AIDS: high-resolution CT findings

Abstract

Pulmonary involvement in children with acquired immunodeficiency syndrome (AIDS) represents a wide spectrum of diseases. Among the non-infectious, non-neoplastic affections associated with AIDS, lymphocytic interstitial pneumonia (LIP) is now a well-recognized entity, but its radiological pattern studied with high-resolution computed tomography (HRCT) has rarely been described in children. The aim of this study was to illustrate the HRCT spectrum of pulmonary involvement in children with LIP and to evaluate its usefulness in the early diagnosis of this entity. Twelve children with AIDS, aged 3-9 years (mean age 5 years 7 months), underwent chest radiographs and HRCT. A control group of 7 healthy aged-matched children was also studied in the same conditions. Diagnosis of LIP was based on clinical data and HRCT findings. Eight children of 12 had a reticulonodular pattern on chest radiographs. Two children had normal chest films and two children showed peribronchiolar thickening. High-resolution CT displayed micronodules, 1-3 mm in diameter, with a perilymphatic distribution in all patients. High-resolution CT demonstrated also subpleural nodules in children without reticulonodular opacities on chest radiographs. High-resolution CT is able to define a more specific pattern of abnormalities than conventional chest radiographs in children with LIP, allows an earlier and more confident diagnosis and may be useful for the detection of other pathologies associated with AIDS, such as opportunistic infections or superimposed malignancies.

Chronic lung disease in human immunodeficiency virus (HIV) infected children

“…18,19 Respiratory status may improve with the use of HAART; 20 amongst HIV-infected adults with LIP, HAART has been reported to produce resolution of radiographic abnormalities. 20 High-resolution CT may improve diagnostic certainty; typical features include micronodules of 1-3 mm in diameter, with a perilymphatic distribution, and subpleural nodules, 21 Figure 4. The role of nuclear scanning in confirming the diagnosis has not been well studied, but diffuse pulmonary gallium uptake has been reported in an HIVinfected child with LIP.…”

Accuracy of high-resolution CT in distinguishing between Pneumocystis carinii pneumonia and non-Pneumocystis carinii pneumonia in AIDS patients

“…High-resolution computed tomography (HRCT) has proved to be useful for the detection and characterization of either infectious or noninfectious diseases in immunocompromised patients with or without AIDS [4], and it is more sensitive than CXR for the detection of PCP in AIDS patients [5]. We carried out a prospective study in HIV-positive patients with severe immunodepression (<200 CD4 lymphocytes/mm 3 ), clinically suspected of lung infection and nonspecific CXR, with the aim of evaluating the usefulness of HRCT for differentiating between infection due to Pneumocystis carinii and infection caused by other microorganisms.…”

High-Resolution CT of the Lung in Children: Clinical Applications

“…The appearance of LIP on chest radiography is nonspecific and includes a fine reticular pattern and nodular opacities or a diffuse confluent pattern. HRCT findings include extensive bilateral ground-glass attenuation, focal air-space consolidation, illdefined, micronodules with a perilymphatic distribution, and thin-walled cystic lesions (Carignan et al 1995;McGuinness and Naidich 1995;Becciolini et al 2001) (Fig. 17).…”