Radiographic features of paediatric pneumocystis pneumonia -- a historical perspective.

AIM: To determine differences between the plain radiographic features of paediatric pneumocystis pneumonia (PCP) recorded before the emergence of human immunodeficiency virus (HIV) in 1982 and those documented in the HIV era. To establish differences in the radiographic features of PCP documented in HIV-infected children in developed and developing countries.

METHOD: A Medline search of articles was conducted from 1950 to 2006, using the terms "pneumocystis pneumonia in children" and "chest radiographic features" or "bilateral opacification" or "lobar consolidation" or "asymmetrical opacification" or "pneumatocoeles" or "cavities" or "pneumothorax" or "pneumomediastinum" or "pleural effusion" or "mediastinal adenopathy" or "nodules" or "normal chest radiography". Appropriate articles were retrieved, radiological data extracted, reference lists examined and hand searches of referenced articles conducted.

RESULTS: Diffuse bilateral "ground-glass" or alveolar pulmonary opacification, which may show some asymmetry, has been consistently documented as the commonest radiographic finding in childhood PCP throughout the period under review. The less common radiological features of PCP in children are similar to those in adults. In developed countries, PCP-related pulmonary air cysts have been reported at an earlier age in HIV-infected children, compared with uninfected children. PCP-related air cysts, pneumothorax, and pneumomediastinum have been reported in children in developed but not in developing countries.

CONCLUSION: The radiological features of paediatric PCP documented before the HIV epidemic are similar to those recorded in the HIV era. Further study of the determinants of the uncommon radiographic features in children is warranted.