To establish the role of HRCT in the early diagnosis of pulmonary disease in symptomatic HIV sero-positive patients with normal chest radiograph

Abstract

In our study of 352 HIV[2] seropositive patients with pulmonary symptoms , 34 patients had normal chest radiograph which is equivalent to 9.66%this value correlates with the study conducted by john segreti et al , who demonstrated the chest radiograph were normal in 10% of his HIV patients with pulmonary symptoms . Among these 34 patients three patients did not turn up for further investigations. Hence only 31 patients were included in this study. In the present study 90.31% of patients belonged to the age group ranging from 20 – 40 years with a mean age of 30.3 years. As this is economically the most productive age group , early diagnosis and treatment of pulmonary disease decreased the morbidity and mortality and economic burden on the society . palmieri F , girandi E et al , in their retrospective study on 146 HIV[2] seropositive patients observed a decrease in survuival among patients with pulmonary TB[1] negative sputum smear and normal chest X- ray at presentation . This was primarily attributed to the delay in the diagnosis of TB and initiation of atituberculosis treatment which results in faster progression of HIV infection . This highlights the importance of early diagnosis and treatment in symptomatic HIV seropositive patients with normal chest x-ray findings in India, where TB contributes the major share for the morbidity and mortality of HIV infection . In this study , lesions in the right and left lung were seen in 8 cases each and in both lungs in 16.12% cases . In the right lung , lesions were seen in 12.9% cases in the upper lobe , 6.45% in middle lobe and 6.45% cases in the lower lobe In the left lung lesions were seen 16.12% cases in the upper lobe , 6.45% cases in the lingual , in 3.22% cases in lower lobe . High resolution CT helps in localizing in the lung where further diagnostic investigations like bronchoscopy , broncho alveolar lavage(BAL)[4] and fine needle aspiration cytology (fnac) can be done where ever necessary. This observation was supported by Kirshenbaum KJ, burke R et al in their study conducted in January 1998. In the present study the following were the CT findings consolidation in 4 cases (12.9%), fibrosis and bronchiectasis in 3 cases(9.67%) and blebs,bullae,ground glass appearance and hilar adenopathy in 1 case (3.22%) each. These findings can help us to suspect it diagnosis and guide us to select necessary specific, invasive and laborious investigations like bronchoscopy ,BAL,FNAC,sputum culture for TB bacilli, staining for pneumocystis carinii etc. to come a specific diagnosis.gruden JF , huang L et al in their study concluded that empirical therapy or immediate bronchoscopy can be avoided in many patients of PCP [3]on the basis of the HRCT findings.