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Pulmonary Infections in Immunocompromised Hosts: The Importance of Correlating the Conventional Radiologic Appearance with the Clinical Setting¹

¹ From the Department of Diagnostic Radiology, Korea University College of Medicine, Seoul, South Korea (Y.W.O.); the Department of Radiology, Children’s Hospital and Medical Center, Seattle, Wash (E.L.E.); and the Department of Radiology, University of Washington Medical Center, Box 357115, Seattle, WA 98195-7115 (J.D.G.). Received July 20, 1998; revision requested November 2; final revision received November 1, 1999; accepted November 10. Address correspondence to J.D.G. (e-mail: godwin@u.washington.edu).

The lung is one of the most frequently involved organs in a variety of complications in the immunocompromised host. Among the pulmonary complications that occur in this kind of patient, infection is the most common and is associated with high morbidity and mortality. Although chest radiography and computed tomography (CT) are essential diagnostic tools, radiologists often have difficulty in establishing the correct diagnosis on the basis of radiologic findings alone. The reasons are that the immunocompromised host is potentially susceptible to infection from many different microorganisms and that radiologic findings are seldom specific for the detection of a particular pathogen. Experience has shown that a particular clinical setting predisposes patients to infection by particular pathogens. The setting comprises (a) the specific epidemiologic or environmental exposure, (b) the type of underlying immune defect, (c) the duration and severity of immune compromise, and (d) the progression rate and pattern of the radiologic abnormality. Correlating the radiologic appearance with the clinical setting can expedite diagnosis and appropriate therapy. In this review, the authors describe the clinical settings that are helpful in choosing the radiologic approach to treatment of the immunocompromised host who presents with suspected pulmonary infection.

Index terms: Acquired immunodeficiency syndrome (AIDS), 60.2518 • Immunity • Lung, CT, 60.12111, 60.12112, 60.12118 • Lung, diseases, 60.20, 60.21, 60.23, 60.25, 60.27 • Lung, infection, 60.20

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