Imaging
Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology.
The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend. Those who care for patients with pulmonary, critical care or sleep disorders rely heavily on chest radiology and pathology to determine diagnoses. The Southwest Journal of Pulmonary, Critical Care & Sleep publishes case-based articles with characteristic chest imaging and related pathology. The editor of this section will oversee and coordinate the publication of a core of the most important chest imaging topics. In doing so, they encourage the submission of unsolicited manuscripts. It cannot be overemphasized that both radiologic and pathologic images must be of excellent quality. As a rule, 600 DPI is sufficient for radiographic and pathologic images. Taking pictures of plain chest radiographs and CT scans with a digital camera is strongly discouraged. The figures should be cited in the text and numbered consecutively. The stain used for pathology specimens and magnification should be mentioned in the figure legend.
Medical Image of the Week: Cytomegalovirus Pneumonia
Figure 1. CT Chest, coronal cut showing left lower lobe consolidation.
Figure 2. Pap stain highlights an enlarged cytomegalovirus-infected pneumocyte containing a single, dark intranuclear inclusion (arrow) with surrounding halo, giving the cell a characteristic “owl’s eye” appearance. Background cells consist of predominantly of macrophages and red blood cells (100x).
Figure 3. CMV-infected pneumocyte demonstrating an enlarged nucleus with a single dense intranuclear inclusion. The cytoplasm contains smaller basophilic inclusions with vacuolization and cytoplasmic projections (Pap stain, 100x).
A 29 year-old female with a history of systemic lupus erythematosus presented with a seven-day history of fever, dyspnea and a non-productive cough. She underwent renal transplantation four weeks prior to admission and was maintained on mycophenolate, tacrolimus, prednisone and prophylactic fluconazole, trimethoprim/sulfamethoxazole and valgangcyclovir. A CT chest was performed (Figure 1) and revealed left lower lobe consolidation. A BAL was performed in the left lower lobe and the cell count revealed 50% lymphocytes, 13% neutrophils and 37% macrophages. The BAL Papanicolaou stain showed enlarged cytomegalovirus-infected pneumocytes with the characteristic “owl’s eye” appearance (Figures 2 and 3). CMV quantitative PCR from serum resulted 648,615 IU/m. The BAL culture grew CMV. The patient was started on treatment with valgangcyclovir with clinical improvement.
While often thought of as a “pneumonitis” with diffuse infiltrates, CMV can cause a lobar pneumonia in up to 30% of patients. Prophylaxis is effective, but cases can occur despite a preemptive strategy.
Nathaniel Reyes MD*, Julianna J. Weiel MSII+, Erika R. Bracamonte MD+, Linda Snyder MD*
Department of Medicine, Division of Pulmonary and Critical Care Medicine*
Department of Pathology+
University of Arizona
Tucson, Arizona
Reference
Kang E, Patz E, Miller NL. Cytomegalovirus pneumonia in transplant patients: CT findings. J Comput Assisted Tomogr. 1998:20:295-9. [CrossRef]
Reference as: Reyes N, Weiel JJ, Bracamonte ER, Snyder L. Medical image of the week: cytomegalovirus pneumonia. Southwest J Pulm Crit Care. 2013;7(4):221-2. doi: http://dx.doi.org/10.13175/swjpcc131-13 PDF