Rapid-growth pneumatocele mimics massive pneumothorax in a HIV-positive patient
- 1Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- 2Department of Surgery, National Yang-Ming University Hospital, Yilan, Taiwan
- 3Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- 4AIDS Prevention and Research Center, National Yang-Ming University, Taipei, Taiwan
- 5Division of Infectious Diseases, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- 6National Yang-Ming University School of Medicine, Taipei, Taiwan
- Correspondence to Dr Chien-Sheng Huang, Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, No 201 Section 2 Shih-Pai Road, Taipei 112, Taiwan;
Contributors M-SH was involved in collecting clinical information and drafting the manuscript. C-CK analysed the radiological studies. WW-W carried out the patient care clinically and helped to draft the manuscript. C-SH provided the operative images and wrote the manuscript.
- Received 3 April 2012
- Accepted 11 June 2012
- Published Online First 26 June 2012
A fast-growing giant pneumatocele can develop in the HIV-positive patient with suspected PCP infection complicated with pneumothorax and compromised pulmonary reserve. CT scans might be helpful for differential diagnosis.
Surgical intervention by video-assisted thoracoscopic surgery for unroofing the pneumatocele and pleurodesis might be an effective treatment to resolve the respiratory comprise and pneumothorax.
We present a rare fast-growing giant pneumatocele in a patient presenting with suspected pneumocystis pneumonia (PCP) infection and bilateral pneumothoraces as a primary manifestation of AIDS (HIV viral loading test: 628 000 copies/ml). Tube thoracostomies were performed and complicated with enduring air leakage and subcutaneous emphysema. Follow-up chest x-rays showed an enlarging radiolucency over the left upper lung field that was interpreted as massive pneumothorax with passive lung atelectasis. Positive ventilation was also applied due to disease progression (The CD4+ T-lymphocyte count was 18/cu mm). Repeated chest CT scans disclosed a newly formed giant bullous-liked lesion in the left upper lung field (figure 1). Video-assisted thoracoscopic surgery for unroofing the cystic lesion (pneumatocele) and pleurodesis successfully allowed the patient to wean from the ventilator and be discharged uneventfully (figure 2).
HIV with PCP infection complicated with necrotising alveolitis in the subpleural pulmonary parenchyma that resulted in pneumothorax and pneumatocele have been well reported.1 ,2 Nonetheless, a rapid-growth giant pneumatocele could be misinterpreted as massive pneumothorax without expectation.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.