LE POLMONITI INFETTIVE NELL'OSPITE IMMUNODEPRESSO: DIAGNOSTICA PER IMMAGINI

Infectious pneumonia is the most frequent complication of the immunocompromised patient and is responsible for an elevated mortality. The authors examine the various infections which can occur in these patients, distinguishing between the ones, which are the most typical of the HIV negative patient, whereas the others can be observed in the AIDS patient. The different infections are analyzed with regard to their prevalence, in relation to the cause of the immunodepression, and the principal radiological characteristics, pointing out the noninfectious pathological manifestations which are important in differential diagnosis. This work constitutes a starting point for the clinical management of the immunocompromised patient, particularly referring to the use of diagnostic imaging and in particular, radiological and nuclear methods. In addition to the radiological examination of the thorax, which constitutes the first step, the CT and nuclear medicine allow us to obtain additional information, sometimes even quicker for some forms of pneumonia, in particular in Pneumocystis carinii. Furthermore they can guide the invasive diagnostic procedures (BAL and biopsy) used for successive microbiological and histological tests. Therefore in these patients, in addition to the clinical evaluation, the contribution given by diagnostic imaging is of paramount importance. Although they are unable to provide a certain diagnosis regarding the exact natare of the disease, they are indispensable for a correct knowledge of the pulmonary pathology that can be observed in these patients.