Institute of Radiology, Department of Medicine, University of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
Division of Haematology and Stem Cell Transplantation, University Hospital of Udine, Azienda Sanitaria Universitaria Integrata di Udine, p.le S. Maria della Misericordia 15, 33100, Udine, Italy.
Eur J Radiol. 2019 Jul;116:116-127. doi: 10.1016/j.ejrad.2019.04.025. Epub 2019 May 1.
Pneumocystis jirovecii pneumonia (PJP) has emerged as a main issue in non Human Immunodeficiency Virus (HIV) immunocompromised hosts, exposing patients to high mortality rates, especially when the diagnosis is delayed. Since microbiological confirmation is often unfeasible or difficult to obtain, High-resolution Computed Tomography (HRCT) represents a main tool for guiding the diagnosis in the appropriate clinical scenario. Nevertheless, radiologists must be aware that PJP at HRCT is a multifaceted process, with a variety of common and less frequent findings, along with a broad spectrum of infectious (e.g., viral and certain fungal and bacterial pneumonias) and non-infectious (e.g., pulmonary oedema, diffuse alveolar haemorrhage, and drug toxicity) differential diagnoses. In this review we resume background clinical information on PJP in non-HIV immunocompromised patients, illustrate both typical and less frequent HRCT findings, and present the spectrum of infectious and non-infectious mimickers at HRCT, highlighting the similarities with PJP and providing clues for the differential diagnosis.
卡氏肺孢子虫肺炎（Pneumocystis jirovecii pneumonia，PJP）已成为非人类免疫缺陷病毒（HIV）免疫功能低下宿主的主要问题，使患者面临高死亡率，尤其是在诊断延迟的情况下。由于微生物学确认通常不可行或难以获得，高分辨率计算机断层扫描（High-resolution Computed Tomography，HRCT）是指导适当临床情况下诊断的主要工具。然而，放射科医生必须意识到，HRCT 上的 PJP 是一个多方面的过程，具有各种常见和较少见的表现，以及广泛的感染性（例如病毒性和某些真菌性和细菌性肺炎）和非感染性（例如肺水肿、弥漫性肺泡出血和药物毒性）鉴别诊断。在这篇综述中，我们总结了非 HIV 免疫功能低下患者中 PJP 的背景临床信息，阐述了 HRCT 上的典型和较少见表现，以及 HRCT 上感染性和非感染性模拟物的范围，突出了与 PJP 的相似之处，并提供了鉴别诊断的线索。
