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247 25 25 5 5 M. M. Ambrosino K. J. Roche N. B. Genieser A. Kaul R. M. Lawrence Department of radiology New York University Medical Center and Bellevue Hospital Center 530 First Avenue 10016 New York NY USA Department of Pediatrics New York University Medical Center and Bellevue Hospital Center 530 First Avenue 10016 New York NY USA Abstract The aim of this study was to evaluate the usefulness of thinsection low-dose computed tomography (TSCT) in the management of children with AIDS, as chest radiographs (CXR) often fail to adequately explain the patients' clinical status. We performed 54 noncontrast TSCTs on 32 children. The patients, aged from 3 months to 14.6 years, were diagnosed as having bacterial pneumonia, lymphocytic interstitial pneumonitis (LIP), Pneumocystis carinii pneumonia (PCP), or Mycobacterium avium-intracellulare infection (MAI). The scans were correlated with the clinical diagnosis, T-lymphocyte-subset percentages, and p24-antigen levels. Subsegmental consolidations were seen in patients with LIP, PCP, and MAI, and as an isolated finding in those with only bacterial pneumonia. Ground-glass haziness was seen exclusively with acute PCP. Reticulonodular thickening was identified only in patients with LIP. Mosaic perfusion was seen with MAI, LIP, and pneumonia. The presence of adenopathy correlated with CD4 + T-cell-subset percentages. The greatest value of CT in this study was in detecting new disease when chest films failed to correlate with a patient's clinical state, and in demonstrating acute/subacute disease in patients with severe baseline chestfilm changes. Recurrent pneumonias may represent progression of “smoldering” disease, rather than true recurrent disease following complete clearing. Adenopathy with low CD4 + levels should suggest lymphoma or infection with MAI.
Pediatric Radiology – Springer Journals
Published: Jul 1, 1995
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