title: Chest radiograph interpretation of Pneumocystis carinii pneumonia, bacterial pneumonia, and pulmonary tuberculosis in HIV-positive patients: accuracy, distinguishing features, and mimics.
abstract: 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.
authors.affiliation: Department of Diagnostic Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.
authors.forename: P M
authors.initials: PM
authors.lastname: Boiselle
authors.forename: I
authors.initials: I
authors.lastname: Tocino
authors.forename: R J
authors.initials: RJ
authors.lastname: Hooley
authors.forename: A S
authors.initials: AS
authors.lastname: Pumerantz
authors.forename: P A
authors.initials: PA
authors.lastname: Selwyn
authors.forename: V P
authors.initials: VP
authors.lastname: Neklesa
authors.forename: R C
authors.initials: RC
authors.lastname: Lange
mesh_terms: 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*