Fig. 17

Fungal Infection. Frontal chest radiograph in a 13-year-old HIV-positive male child, presented with fever & cough for 4 days, shows diffuse haze/GGO involving left lung (asterisk, A), and patchy areas of inhomogenous opacity in right lung (white arrows, A). Pulmonary bay fullness with peripheral pruning of pulmonary arteries (suggesting pulmonary hypertension) is evident (black arrow, A). CT scan (axial, lung window) shows GGO involving anterior segment of RUL, apico-posterior segment of LUL and superior, anteromedial & lateral basal segments of LLL (thick white arrows in B,C,D,E). Ill-defined centrilobular nodules are also visible in similar anatomic locations (black arrows in B,C). GGO along with interlobular septal thickening in superior segment of LLL gave crazy paving appearance to the involved segment (thick white arrow, D). Bilateral cystic & traction bronchiectatic changes are also present (thin white arrows, E). Enlarged pulmonary artery suggestive of pulmonary hypertension (arrow, F) is evident on axial CECT chest (mediastinal window). CD4 count was 131 cells/cu.mm. BAL/sputum did not isolate any microorganism. Patient was clinically sick and hypoxic. On the basis of clinical and radiological findings, a probable diagnosis of Pneumocystis jiroveci pneumonia was made. Patient was treated with trimethoprim/sulfamethoxazole combination and improved clinically as well as radiologically (G)