Image Challenge of the Week!

A patient with AIDS presents with acute dyspnea. An ultrasound probe is placed on his lateral chest wall producing the following image:

https://lifeinthefastlane.com/ultrasound

What is the name of the above finding and the associated diagnosis? What is likely the underlying cause of the above diagnosis?

Scroll down for the answer.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Answer: 

The ultrasonographic finding is called the “lung point sign,” which is highly specific (near 100% specificity) for pneumothorax. In a patient with AIDS and spontaneous pneumothorax, there should be high suspicion for recent or acute Pneumocystic jiroveci pneumonia.

Discussion:

The following video explains the characteristics of the lung point sign.

Among patients with AIDS who spontaneous pneumothorax, the likelihood of acute or recent Pneumocystis jireveci pneumonia is incredibly high (86% in one series. Clin Infect Dis. 1996 Sep;23(3):624-7.). In HIV-seropositive patients with CD4+ lymphocyte greater than 200 cells/mL and without AIDS criteria, the most common etiology is bacterial pneumonia (Eur J Radiol. 2009 Aug;71(2):264-8).