Contents
1 Imaging findings of bacterial pneumonia in AIDS.1
1.1 Introduction.1
1.2 Imaging findings.2
2 Imaging findings of AIDS with pulmonary Rhodococcus equi disease.13
2.1 Introduction.13
2.2 Imaging findings.14
2.3 Imaging features.21
3 Imaging manifestation of pulmonary candidiasis in AIDS.22
3.1 Introduction.22
3.2 Imaging findings.23
3.3 Imaging features.32
4 Imaging findings of pulmonary aspergillosis in AIDS.33
4.1 Introduction.33
4.2 Imaging findings.34
4.3 Imaging features.43
5 Imaging findings of pulmonary mucormycosis in AIDS.44
5.1 Introduction.44
5.2 Image findings.45
5.3 Imaging features.56
6 Imaging findings of pulmonary cryptococcosis in AIDS.58
6.1 Introduction.58
6.2 Image findings.58
6.3 Imaging features.64
7 Imaging features of penicilliosis marneffei in AIDS.65
7.1 Introduction.65
7.2 Image findings.66
7.3 Imaging features.82
8 Image findings of pneumocystis pneumonia PCP in AIDS.83
8.1 Introduction.83
8.2 Image findings.84
8.3 Imaging features.98
VI .Contents
9Imaging findings of pulmonary Mycobacterium tuberculosis in AIDS.99
9.1 Introduction.99
9.2 Radiologic findings.100
9.3 Imaging features.114
10Imaging findings of nontuberculous mycobaterial pulmonary infection in AIDS.116
10.1 Introduction.116
10.2 Radiographic findings.117
10.3 Imaging features.124
11Imaging findings of CMV pneumonia in AIDS.126
11.1 Introduction.126
11.2 Imaging findings.127
11.3 Imaging features.138
12Imaging features of multiple microbial pulmonary infections in AIDS.139
12.1 Introduction.139
12.2 Imaging features.162
13Imaging findings of AIDS-related Lymphoma.163
13.1 Introduction.163
13.2 Radiologic findings.164
13.3 Imaging features.173
14Abdominal CT findings in AIDS..174
14.1 Introduction.174
14.1.1 Liver and spleen.174
14.1.2 Biliary system.175
14.1.3 Retroperitoneal and mesentery lymph nodes.175
14.1.4 Kidney and adrenal glands.176
14.1.5 Digestive tract.176
14.1.6 Pelvic cavity and abdominal.176
14.1.7 Peritonitis and ascites.176
14.2 Abdominal CT findings of PM infection in AIDS.177
14.2.1 Introduction.177
14.2.2 Radiologic findings.177
14.2.3 Imaging features.196
14.3 Abdominal CT findings of abdominal tuberculosis in AIDS.197
14.3.1 Introduction.197
14.3.2 Radiologic findings.198
14.3.3 Imaging features.215
Contents.VII
15Thoracic and abdominal imaging features of pediatric AIDS.217
15.1Introduction.217
15.2Radiologic findings.217
15.3Imaging features.234
16CT diagnoses and differential diagnoses of mediastinal hilar lymphadenopathy in AIDS patients.236
16.1The imaging features of mediastinal hilar lymphadenopathy in AIDS patient.236
16.1.1Opportunistic infections.236
16.1.2Tumors.237
16.2The imaging features and differential diagnosis of mediastinal hilar lymphadenopathy in AIDS patient.238
16.2.1Size of lymph nodes.238
16.2.2Density of lymph nodes and enhancement mode.238
16.2.3Diffuse miliary lesions.238
16.2.4Primary complex or similar-primary complex.239
16.2.5Mesenteric lymphadenopathy Sandwich sign.239
16.2.6Pleural effusion and pericardial effusion.239
17CT diagnoses and differential diagnoses of cavitary pulmonary diseases in AIDS patients..255
17.1AIDS-associated TB.256
17.2AIDS-associated NTM diseases.262
17.3AIDS-associated pulmonary abscess.265
17.3.1AIDS-associated pulmonary mycosis.269
18The CT diagnosis and differential diagnosis of disseminated miliary nodules in AIDS patients.275
18.1Introduction.275
References.298
Index.303
內容試閱：
Foreword
In recent years, HIVAIDS-related opportunistic infections have drawn worldwide attention only due to their escalating prevalence and their complexity in etiology. From their onsets to their progress in the course, opportunistic infections vary in terms of different stages and different immunosuppression of hosts. In the advanced stage of AIDS, they may lead to multiple complications simultaneously. As a result, they present varying unspecific manifestations in imaging so that to make an affirma-tive diagnosis we depend more on the clinical observations and laboratory data, espe-cially the results from bacterial culturing and pathological analyses. But the particu-larity of AIDS allows few chances for us to obtain the specimen for biopsy. Favorably, the radiological examinations on the AIDS-related infections have the advantage of non-invasiveness, accurate location of lesions, full scale of observation and repeata-bility, which no doubt to say makes imaging diagnoses so valuable for the detection, diagnosis, treatment and prognosis of AIDS-induced opportunistic infections.
Guangzhou No..8 Hospital is a government-run hospital, only designated by the local government to service the AIDS patients in South China. In the past twenty years, we have attained fair knowledge and rich experience in prevention and treat-ment of AIDS-related opportunistic infections. In the context, the two experts, Prof. Jinxin Liu and Prof. Xiaoping Tang from the hospital, co-worked hard to compile the book, An Atlas of Thoracic and Abdominal Images of AIDS Patients, which I believe is of significance for clinical reference.
The book contains 15 chapters and has collected in it more than 101 cases of AIDS-related infections and over 1,000 radiographic and CT images with rich legends, which is a general summary of clinical studies on AIDS-related opportunistic infec-tions in recent years. Therefore, I wish that this book would play a role in promoting the clinical diagnosis and treatment of AIDS patients.
May 1, 2010 Academician of Chinese Engineering Academy Fuwai Hospital of Chinese Academy of Medical Sciences
Preface
AIDS acquired immunode.ciency syndrome is a severe clinical immunosuppressive syndrome caused by human immunodeficiency virus HIV infection. By severely suppressing human T lymphocyte immune function, HIV may induce various malig-nant tumors and all kinds of opportunistic infections. The opportunistic infections are commonly caused by fungi, bacteria and viruses, and clinically show the manifes-tations of fever, weight loss and systemic lymphadenopathy.
Epidemically, AIDS has spread rapidly worldwide since the first AIDS case was detected in America in 1981. According to UNAIDS Report on the Global AIDS Epi-demic 2009 and 2010 Prospects in Prevention and Care of AIDS, at least 60 million people were infected by HIV and 25 million of them died of AIDS-related diseases. In 2008, comparatively, only 33.4.million were HIV-infected including 2.7.million new victims and 2 million died of AIDS.
The similar situation happens in China for the rapid increase of HIV cases. By the end of October 2009, 319,877 HIVAIDS patients were reported and documented. Of them 102,323 were AIDS patients and 46,845 died. Comparatively, the prevalence of AIDS epidemic was so late that the majority of medical imageologists in China are green hands in terms of full-scale and systematic investigations in AIDS imageology. At this point, it is essential for medical doctors to familiarize themselves with clinical and imaging manifestations of AIDS.
Clinically, imageological examinations can present the lesions caused mainly by opportunistic infections and partly by HIV infections. The imaging manifestations of AIDS with opportunistic infections are characterized by complexity and non-speci-ficity only because AIDS patients can contract various different opportunistic infec-tions due to individual immunosuppression at the different stages of AIDS. In this case, the diagnoses of opportunistic infections in AIDS patients are dependent on clinical symptoms, imaging data, experimental results and most importantly, bac-terial identification and pathological analyses. Therefore, specimen collections and biopsies become essential and fundamental for the diagnoses. But the particularity of AIDS makes clinical diagnosis tricky in China. Luckily, the imaging examinations are advantageous for its noninvasiveness, repeatability, accurate location and full-scale observation, which together contribute the great value to the identification, assess-ment of curative effect and prognosis of AIDS.
Opportunistic infections most commonly involve the thoracic and abdominal organs and tissues, which are most available for specimen collection and biopsy for the sake of affirmative diagnoses. For recent years, we have undertaken a number of imaging diagnoses of typical opportunistic infections in AIDS patients in Guangzhou No..8 Peoples Hospital. Therefore, we would like to share our experience in imaging diag-noses of the opportunistic infections with peers as well as other clinical doctors by gathering, compiling and publishing the imaging findings from our clinical practice. The atlas is a collection of images on AIDS patients together with respective legends.
Preface.III
It elaborates not only the imaging features of AIDS patients by dynamically presen-ting the thoracoabdominal images and depicting the onset and progress of each AIDS case, but the onset, progress, treatment and improvement of AIDS-induced oppor-tunistic infections of all kinds as well by integrating the clinical data of each case. From this point of view, the book is a complete summary of thoracoabdominal diag-nostic imaging and treatment of AIDS patients and therefore is of great value for the clinical diagnosis and treatment of AIDS.
Thanks to the hard work of all other compilers, the atlas is successfully completed. We would like to thank the leaders of Guangzhou No..8 Peoples Hospital. It could not be so smooth and successful without their support. Moreover, we really wish to express our gratitude to Prof. Yuqing Liu, academician of the Chinese Academy of Engineering, who wrote the preface for the atlas. Finally, we are strongly hopeful that the peer experts as well as the readers in this discipline would not bother to dedicate their critics on this book only because there may be some mistakes in it for the sake of our limited clinical experience and the rapid development of imaging technology.
LIU Jin-xin, TANG Xiao-ping March 15, 2010
Preface of second edition
As time flies, it has been over three years since the publishing of An Atlas of Tho-racic and Abdominal Images of AIDS Patients. Happily, a few doctors or researchers have still asked me for the book until yesterday, indicating that it is still valuable to a certain extent though it needs further supplementing and perfecting.
I cant help feel his hardship when I have been pondering over the words by Prof. Yanhao Li in the preface of the third edition of his works： Writing is hard, but writing with your heart is harder since I submitted the first edition of manuscript in 2010. This empathy pushed me for my preliminary and major principles for my passion to compile this book： 1. Authenticity of the data for the atlas is predominant, with fewer textual descriptions as well as our own insights; 2. After it comes familiarity, e.g., We should compile in it what we have studied and mastered; 3. The book needs constant enrichments by accumulating latest scientific findings.
Nowadays, sources for solving problems are always available on line by surfing in and downloading from the Internet. However, they are controversial when it comes to their authenticity. Only the authentic first-hand image data are of great value for the scientific research.
Currently, the cases of AIDS still remain relatively rare in most hospitals in China. More importantly, a lot of my peers just hold an incomplete picture of it from the pros-pective of its imaging manifestations. This status certainly arouses our interest in the compilation of the atlas. Therefore, we gathered the first-hand image data based on our long-term experience in 2010, in hopes that these collected data could facilitate the readers with a comprehensive understanding of AIDS-related opportunistic infec-tions from the future perspective.
The second edition of the atlas come out with new cases by differential diagnosis and more importantly latest achievements we have harvested through these years, which hopefully could be referential and helpful for our peers.
Writing is always a matter of regret. Therefore, we are strongly hopeful that the peer experts would not bother to dedicate their critics on this book only because there may be some mistakes in it for the sake of our limited clinical knowledge.
LIU Jin-xin May 1, 2014
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