APPLICATION OF THIN-SECTION LOW-DOSE CHEST CT (TSCT) IN THE MANAGEMENT OF PEDIATRIC AIDS

The aim of this study was to evaluate the usefulness of thin-section l ow-dose computed tomography (TSCT) in the management of children with AIDS, as chest radiographs (CXR) often fail to adequately explain the patients' clinical status. We performed 54 noncontrast TSCTs on 32 chi ldren. The patients, aged from 3 months to 14.6 years, were diagnosed as having bacterial pneumonia, lymphocytic interstitial pneumonitis (L IP), Pneumocystis carinii pneumonia (PCP), or Mycobacterium avium-intr acellulare infection (MAI). The scans were correlated with the clinica l diagnosis, T-lymphocyte-subset percentages, and p24-antigen levels. Subsegmental consolidations were seen in patients with LIP, PCP, and M AI, and as an isolated finding in those with only bacterial pneumonia. Ground-glass haziness was seen exclusively with acute PCP. Reticulono dular thickening was identified only in patients with LIP. Mosaic perf usion was seen with MAI, LIP, and pneumonia. The presence of adenopath y correlated with CD4(+) T-cell-subset percentages. The greatest value of CT in this study was in detecting new disease when chest films fai led to correlate with a patient's clinical state, and in demonstrating acute/subacute disease in patients with severe baseline chest-film ch anges. Recurrent pneumonias may represent progression of ''smoldering' ' disease, rather than true recurrent disease following complete clear ing. Adenopathy with low CD4(+) levels should suggest lymphoma or infe ction with MAI.