Pulmonary infections in HIV-positive children.

Infection of the lungs and airways by viral, bacterial, fungal and protozoal agents, often producing atypical radiographic features, is common in children with human immunodeficiency virus (HIV) infection. Conventional chest radiography and chest CT remain the most useful imaging modalities for evaluation of the immunocompromised patient presenting with a suspected pulmonary infection. In this review the radiological features of acute lung infections in this population are discussed.

Non-infective pulmonary disease in HIV-positive children.

It is estimated that over 90% of children infected with human immunodeficiency virus (HIV) live in the developing world and particularly in sub-Saharan Africa. Pulmonary disease is the most common clinical feature of acquired immunodeficiency syndrome (AIDS) in infants and children causing the most morbidity and mortality, and is the primary cause of death in 50% of cases. Children with lung disease are surviving progressively longer because of earlier diagnosis and antiretroviral treatment and, therefore, thoracic manifestations have continued to change and unexpected complications are being encountered. It has been reported that 33% of HIV-positive children have chronic changes on chest radiographs by the age of 4 years. Lymphocytic interstitial pneumonitis is common in the paediatric HIV population and is responsible for 30-40% of pulmonary disease. HIV-positive children also have a higher incidence of pulmonary malignancies, including lymphoma and pulmonary Kaposi sarcoma. Immune reconstitution inflammatory syndrome is seen after highly active antiretroviral treatment. Complications of pulmonary infections, aspiration and rarely interstitial pneumonitis are also seen. This review focuses on the imaging findings of non-infective chronic pulmonary disease.

Unusual forms of spinal tuberculosis.

OBJECTIVE: The incidence of tuberculosis (TB) is increasing in both developing and developed worlds, and children, in particular, represent a high-risk group for acquiring the disease. TB of the central nervous system is the most severe, life-threatening form of TB in infants and children. Approximately 10% of all patients with TB have central nervous system involvement. MATERIALS AND METHODS: We have selected four pediatric cases of unusual spinal TB that presented to our institution during the last 5 years. These include TB arachnoiditis, intramedullary spinal cord tuberculoma, TB spondylitis of the odontoid peg, and one child with tuberculous extradural abscess. CONCLUSION: TB may involve the intramedullary, extramedullary intrathecal compartment, or the extrathecal vertebral compartment in the form of an arachnoiditis, abscess, and spondylitis, respectively, often with unusual imaging presentations.

Pulmonary Kaposi sarcoma in six children.

BACKGROUND: Pulmonary involvement in Kaposi sarcoma is rare in children and can be difficult to distinguish from other pathology. OBJECTIVE: To describe the radiological findings in paediatric pulmonary Kaposi sarcoma. MATERIALS AND METHODS: Sequential chest radiographs of six children and CT scans of four of these children were evaluated retrospectively. Their ages ranged from 18 months to 10 years; four were male and two were female. All six children were HIV-positive. The observers were two radiologists. RESULTS: Chest radiographs revealed air-space (100%) and reticular (83%) opacification in the mid- and lower lung zones; pleural effusions were present in 83% of the children. All the children showed progressive air-space opacification on follow-up radiography. CT demonstrated bilateral air-space opacification in a perihilar distribution in all the children; reticular opacification was seen in 75%. All the children had mediastinal and axillary lymphadenopathy; 75% had bilateral hilar lymphadenopathy. CONCLUSION: In both adults and children, chest radiography demonstrates perihilar and lower zone involvement. Pleural effusions are more common on radiographs in children. Air-space disease and lymphadenopathy are much more common on CT in children than adults.

Multiplanar angled reconstructions of reconstructions--a dangerous practice using multidetector CT.

This case illustrates the dangers of using reconstructions to correct for positioning in multiplanar CT scans and using images that have already been reconstructed rather than the original source images. We present a case where a subdural haemorrhage was simulated by reconstructing already reconstructed images.