首页   按字顺浏览 期刊浏览 卷期浏览 Shortcomings of Chest Radiography in Detecting Pneumocystis carinii Pneumonia
Shortcomings of Chest Radiography in Detecting Pneumocystis carinii Pneumonia

 

作者: Milos Opravil,   Borut Marincek,   Walter Fuchs,   Rainer Weber,   Rudolf Speich,   Manuel Battegay,   Erich Russi,   Ruedi Lüthy,  

 

期刊: Journal of Acquired Immune Deficiency Syndromes  (OVID Available online 1994)
卷期: Volume 7, issue 1  

页码: 39-45

 

ISSN:0894-9255

 

年代: 1994

 

出版商: OVID

 

关键词: Pneumocystis cariniipneumonia;Chest roentgenogram;Diagnosis;Human immunodeficiency virus infection;Mortality;Interobserver variability.

 

数据来源: OVID

 

摘要:

SummaryThe radiographic presentation ofPneumocystiscarinii pneumonia (PCP) was studied in 93 consecutive patients to determine the frequency of normal findings on chest roentgenograms and possible correlations with clinical or laboratory findings. The roentgenograms were reviewed by two radiologists in an independent, blinded way and judged with a score distinguishing between none, interstitial, and acinar infiltrates. Discordance mainly between absent versus interstitial and interstitial versus acinar infiltrates occurred in 23% of roentgenograms and was settled by consensus. The majority of patients presented with moderate-to-mild symptoms; the combination of dyspnea, cough, and fever was present in 53%. Lactate dehydrogenase (LDH) was elevated in 63%, hypoxemia (PaO2< 75 mm Hg) was present in 57%. Findings on chest roentgenograms were normal in 39%, whereas 36% showed interstitial and 25% acinar infiltrates. These three radiographic groups represented an increasingly severe PCP, indicated by higher LDH levels and hypoxemia (bothp< 0.05). In a multivariate logistic regression, normal roentgenograms were predicted by low LDH and low peripheral blood granulocytes (p< 0.005). Mortality within 3 weeks was only 4% and correlated with the severity of infiltrates (p< 0.05). Normal roentgenograms thus corresponded to an oligosymptomatic, less severe PCP. In immunodeficient HIV-infected patients, a normal chest roentgenogram does not exclude PCP and should not distract from attaining a definite diagnosis by examination of induced sputum or bronchoalveolar lavage.

 

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