Q: 62 year old male with known history of HIV presented to ER with SOB. CXR revealed unilateral spontaneous pneumothorax, otherwise parenchyma on both sides appears normal. What would be your concern?



Answer:  Pneumothoraces in HIV patients should be read as PCP (Pneumocystis jirovecii) infection, proved otherwise. Prompt evaluation should be initiated, and treatment should not be delayed. About 25% of HIV patients with PCP may have normal chest x-rays at least in the beginning of the disease.


Reference: 

DeLorenzo LJ, Huang CT, Maguire GP, Stone DJ. Roentgenographic patterns of Pneumocystis carinii pneumonia in 104 patients with AIDS. Chest 1987; 91:323.