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Nodule size on HRCT scanning may predict infectious agent aetiology in immunocompromised patients with suspected pulmonary infection
  1. C M O’Driscoll
  1. Consultant Radiologist, Royal United Hospital, Bath, UK, Martin.ODriscollruh-bath.swest.nhs.uk

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This review of HRCT findings in 78 immunocompromised patients with a diagnosis of a proven infectious agent included patients with AIDS (n=25) or bone marrow transplantation (n=21). Patients with typical HRCT features of infectious bronchiolitis and endobronchial spread of tuberculosis (branching linear or nodular opacities, tree-in-bud pattern) were excluded.

Nodules were categorised by size, cross sectional distribution, and five other features. 92% had multiple bilateral nodules. Infectious agents were Mycobacterium (n=24), fungi (n=22), and viruses (n=12). There was no case of miliary tuberculosis. Univariate analysis showed that absence of cavitation, small size, and “halo sign” were significantly associated with viral aetiology. Multivariate analysis indicated that a diameter of <10 mm was the only independent predictor of aetiology (p<0.0001).

The authors conclude that, in immunocompromised patients with multiple non-miliary nodules on CT scanning and suspected pulmonary infection, nodule size of uniformly <10 mm predicts a viral aetiology.

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