Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia, and pulmonary tuberculosis in HIV-positive patients: accuracy, distinguishing features, and mimics.
The purpose of this study was to assess the accuracy of chest x-ray (CXR) interpretation in the diagnosis of pneumocystis carinii pneumonia (PCP), bacterial pneumonia (BP), and pulmonary tuberculosis (TB) in human immunodeficiency virus (HIV)-positive patients and to identify the frequency with which these infections mimic one another radiographically. The admitting CXRs of 153 HIV-positive patients with laboratory proven BP (n = 71), PCP (n = 73), and TB (n = 9) and those of 10 HIV-positive patients with no active disease were reviewed retrospectively and independently by three radiologists who were blinded to clinical and laboratory data. Median percent accuracies were as follows: TB, 84%; PCP, 75%; BP, 64%; and no active disease, 100%. Fifteen of 153 cases (9.8%) were shown to mimic other infections radiographically. A confident and accurate diagnosis can be made radiographically in the majority of cases of PCP, BP, and TB in HIV-positive patients at the time of hospitalization. In approximately 10% of cases, these infections may mimic one another radiographically.
Boiselle
P M
PM
Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.
Tocino
I
I
Hooley
R J
RJ
Pumerantz
A S
AS
Selwyn
P A
PA
Neklesa
V P
VP
Lange
R C
RC
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D006679:HIV Seropositivity; D006801:Humans; D015588:Observer Variation; D018410:Pneumonia, Bacterial / Q000000981:diagnostic imaging*; D011020:Pneumonia, Pneumocystis / Q000000981:diagnostic imaging*; D011859:Radiography; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging*