INDICATION: HIV positive, groundglass infiltrate, ? improvement post Septra treatment.
FINDINGS: Minor deterioration in the groundg lass infiltrate is noted in the posterior aspect of the right upper lobe and in the posterior aspect of the right lower lobe. The remaining areas of ground glass show no interim change. The focal area of rounded pneumonia in the left lower lobe has almost completely resolved in the interim. The small focal area of consolidation in the posterior basal segment right lower lobe is unchanged in appearance in the interim.
Multiple bullae persist predominantly in an upper and mid lung zone distribution. Multiple small shotty lymph nodes also remain in the abdomen and in the mediastinum.
No pleural effusion.
Appearances are still strongly consistent with a PCP. However, given the absence of significant change on Septra, other considerations should also be considered. These would include viral infection, and non-infectious etiologies like RB-ILD and EAA could also give this appearance.