CHEST RADIOGRAPH INTERPRETATION OF PNEUMOCYSTIS-CARINII PNEUMONIA, BACTERIAL PNEUMONIA, AND PULMONARY TUBERCULOSIS IN HIV-POSITIVE PATIENTS- ACCURACY, DISTINGUISHING FEATURES, AND MIMICS

The purpose of this study was to assess the accuracy of chest x-ray (C XR) interpretation in the diagnosis of Pneumocystis carinii pneumonia (PCP), bacterial pneumonia (BP), and pulmonary tuberculosis (TB) in hu man immunodeficiency virus (HIV)-positive patients and to identify the frequency with which these infections mimic one another radiographica lly. The admitting CXRs of 153 HIV-positive patients with laboratory p roven BP (n = 71), PCP (n = 73), and TB (n = 9) and those of 10 HIV-po sitive patients with no active disease were reviewed retrospectively a nd independently by three radiologists who were blinded to clinical an d laboratory data. Median percent accuracies were as follows: TB, 84%; PCP, 75%; BP, 64%; and no active disease, 100%. Fifteen of 153 cases (9.8%) were shown to mimic other infections radiographically. A confid ent and accurate diagnosis can be made radiographically in the majorit y of cases of PCP, BP, and TB in HIV-positive patients at the time of hospitalization. In approximately 10% of cases, these infections may m imic one another radiographically.