Radiographic resolution of lymphocytic interstitial pneumonitis (LIP) in children with human immunodeficiency virus (HIV): not a sign of clinical deterioration.

BACKGROUND: The literature and anecdotal evidence associate the resolution of radiographic findings of lymphocytic interstitial pneumonitis (LIP) with a decline in immune and clinical status of human immunodeficiency virus (HIV) infected children. OBJECTIVE: As our clinical impression was the opposite, we sought to elucidate this contradiction. MATERIALS AND METHODS: Of 52 pediatric patients infected with the HIV currently being followed at our institution, 20 (38.5%) carried the diagnosis of LIP and 13 (65%) of these have had complete resolution of radiographic findings of LIP. We retrospectively reviewed the chest radiographs, CD4 counts, and clinical history of these 13 patients. RESULTS: Of the 13 patients who had resolution of radiographic findings, 11 (84.6%) had no significant change in CD4 count at the time of resolution and remained clinically stable during a mean follow-up period of 32 months. Two patients (15.3%) developed severe CD4 lymphocytopenia at the time of resolution of LIP, but clinically remained stable. None of these 13 patients had a recurrence of LIP, even with subsequent increases in CD4 count. CONCLUSION: We suggest that in contradiction to previously published data, resolution of LIP on chest radiographs is not an indicator for poor prognosis for the HIV-infected pediatric patient.

Congenital tracheoesophageal fistula (H-type) in a six-year-old.

The case of a six-year-old boy with newly diagnosed tracheoesophageal fistula of the H-type is presented. This diagnosis is usually made in the neonatal period, but since the symptoms may mimic other respiratory illnesses and radiologic diagnosis may be difficult, the condition may go undiagnosed for years. Since correction of a tracheoesophageal fistula is curative, the diagnosis should be entertained in any child with recurrent respiratory symptoms, especially when associated with meals. A brief discussion emphasizes the importance of good communication between the clinician and radiologist and of careful radiologic evaluation.