Acute lung disease in the immunocompromised host: Diagnostic accuracy of the chest radiograph

Purpose: To assess the diagnostic accuracy of the chest radiograph in the evaluation of acute pulmonary complications in immunocompromised patients. Methods: The study included the chest radiographs in 149 consecutive acute pulmonary complications seen in immunocompromised patients in whom a definitive diagnosis was made. Twenty-four complications were in patients with AIDS and 125 were in non-AIDS patients. The radiographs were separately reviewed in random order by two independent observers. The observers assessed pattern and distribution of radiographic findings and recorded their first- choice diagnosis. Results: The most common complication in patients with AIDS was Pneumocystis carinii pneumonia (n=21). In the non-AIDS patients, the most common complications included invasive aspergillosis (n=25), drug reaction (n=21), and Pneumocystis pneumonia (n=20). A correct first-choice diagnosis was made in 90% of patients with AIDS and 34% of non-AIDS patients. In AIDS patients with Pneumocystis pneumonia, the correct first-choice diagnosis was made in 41 of 42 (98%) readings by the two observers. In non-AIDS patients with invasive pulmonary aspergillosis, drug reaction, and Pneumocystis pneumonia, the correct first-choice diagnosis was made in 38%, 26%, and 43% of readings, respectively. Conclusion: The chest radiograph is helpful in the differential diagnosis of acute lung disease in the immunocompromised host, particularly in patients with AIDS.