Differences and similarities of cytomegalovirus and pneumocystis pneumonia in HIV-negative immunocompromised patients   thin section CT morphology in the early phase of the disease

doi:10.1259/bjr/39696316

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Differences and similarities of cytomegalovirus and pneumocystis pneumonia in HIV-negative immunocompromised patients – thin section CT morphology in the early phase of the disease

M N Vogel, MD ¹ H Brodoefel, MD ¹ T Hierl, MD ² R Beck, MD ³ W A Bethge, MD ⁴ C D Claussen, PROF ¹ and M S Horger, MD ¹

¹ Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tübingen, ² Institute of Medical Microbiology and Hygiene, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 6, 72076 Tuebingen, ³ Institute of Medical Virology and Epidemiology of Viral Diseases, Eberhard-Karls-University, Elfriede-Aulhorn-Str. 6, 72076 Tuebingen, ⁴ Department of Internal Medicine II, Eberhard-Karls-University, Otfried-Müller-Str. 10, 72076 Tübingen, Germany

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Figure 1. CMV pneumonia in a 39-year-old man with HCT for acute myeloid leukaemia 42 days previously and acute fever beginning the previous day. Thin section CT shows unsharp demarcated regions of GGO with zones of consolidation and centrilobular nodules (arrow).

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Figure 2. PcP in a 60-year-old man with chronic lymphocytic leukaemia following chemotherapy and presenting with acute fever beginning the previous day. Thin section CT shows homogeneous GGO, which forms a mosaic pattern especially in the apical lung section (arrow).

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Figure 3. PcP in a 50-year-old woman after HCT for non-Hodgkin's Lymphoma 88 days previously and acute fever beginning the day of thin section CT despite antibiotic therapy. Patchy, homogeneous GGO is distributed predominantly in the periphery of the lobes.

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Figure 4. CMV pneumonia in a 56-year-old man 17 days after HCT due to acute myeloid leukaemia presenting with breathing problems and fever. The thin section CT shows diffuse consolidation zones, peripheral sparing, septal thickening (arrow) and bilateral pleural effusions.

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Figure 5. PcP in a 40-year-old woman with acute myeloid leukaemia undergoing chemotherapy and presenting with a continuing fever despite antibiotic therapy. The thin section CT shows septal thickening (short, slanted arrow) and GGO (long, straight arrow) in the upper lobes.

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Figure 6. CMV pneumonia in a 51-year-old man following HCT for acute myeloid leukaemia 115 days previously and presenting with acute fever beginning the day before. Thin section CT shows unsharp demarcated focal zones with GGO and septal thickening mainly distributed in the lung periphery.

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Figure 7. CMV pneumonia in a 49-year-old man, 106 days after HCT due to acute myeloid leukaemia. He suffered from constant fever for 2 days, despite antibiotic therapy. The thin section CT shows small areas of consolidation predominantly in the lower lobes and dorsal parts of the lung. Simultaneously, centrilobular nodules, peripheral sparing and unsharp demarcated GGO are present.

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Figure 8. PcP in a 65-year-old woman undergoing steroid medication for therapy of a collagen vascular disease and presenting with dyspnoea and fever beginning the previous day despite antibiotic therapy. The thin section CT shows patchy areas of consolidation, a mosaic pattern (arrow) and peripheral sparing in the upper lobes.