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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.