Differentiation of pulmonary complications with extensive ground-glass attenuation on high-resolution CT in immunocompromised patients

Abstract

Purpose The purpose of this study was to compare the high-resolution CT (HRCT) findings of pulmonary infectious and noninfectious complications with extensive ground-glass attenuation (GGA) in immunocompromised patients. Materials and methods One hundred fifty-two immunocompromised patients with pulmonary complications that showed extensive GGA (> 50% of the whole lung on HRCT) were included in this study. The diagnoses of the 152 patients were as follows: pneumocystis pneumonia (PCP), n = 82; drug-induced pneumonia, n = 38; bacterial pneumonia, n = 9; cytomegalovirus pneumonia, n = 6; idiopathic pneumonia syndrome, n = 6; diffuse alveolar hemorrhage (DAH), n = 4; fungal infection, n = 3; tuberculosis, n = 2 and pulmonary edema, n = 2. Two chest radiologists retrospectively evaluated the CT criteria, which consisted of 12 findings. Results The nodule (p = 0.015), the bronchovascular bundle (BVB) thickening (p = 0.001), and the interlobular septum (ILS) thickening (p = 0.002) were significantly infrequent in PCP. The ILS thickening was significantly frequent in drug-induced pneumonia (p < 0.001) though it was also frequent in other noninfectious and infectious diseases. The BVB thickening was significantly frequent in bacterial pneumonia (p = 0.005). The nodule was significantly frequent in DAH (p = 0.049). Conclusion Nodules, BVB thickening, and ILS thickening could be useful HRCT findings for the differential diagnosis of pulmonary complications in immunocompromised patients with extensive GGA.

COVID-19 in Immunocompromised Patients: A Systematic Review

“…40 However, interpreting diffuse interstitial involvement could be challenging due low specificity of ground-glass opacities in this population. 41 42 43…”

“…40 However, interpreting diffuse interstitial involvement could be challenging due low specificity of ground-glass opacities in this population. [41][42][43] Disease severity and mortality data are retrospective with hospitalization rates varying from 29 to 86% and mortality rates varying from 4 to 36%. Indeed, immunocompromised patients seem to have more severe disease with higher rates of hospital and ICU admission and mortality.…”