Radiographic features in patients with pulmonary manifestations of the acquired immune deficiency syndrome.

The radiographic findings in 14 episodes of pulmonary pathology, occurring in 13 patients with the acquired immune deficiency syndrome (AIDS) are described. The patients presented over a 15-month period. All were homosexual men with serum antibodies to human T-cell lymphotrophic virus III. Pneumocystis carinii pneumonia was the most common manifestation, occurring in seven of the 14 episodes. Radiographic appearances in five of these were classical, with bilateral perihilar ground-glass shadowing initially. In one the appearances were complicated by a superadded bacterial infection and in one the chest radiograph was normal. Bacterial infections occurred in five of the 14 episodes and, when present, showed the characteristic radiographic appearances of the causative organism. Three patients had widespread Kaposi's sarcoma. Bronchoscopy, broncho-alveolar lavage and transbronchial biopsy were often necessary to identify the causative agent. They were also indicated when atypical radiographic appearances occurred during the course of treatment as additional organisms could be found. The radiographic appearances of the conditions reported are felt to be sufficiently characteristic for the radiologist to play a useful role in suggesting the diagnosis and in monitoring the progression of disease in these patients.