Cystic parenchymal changes associated with spontaneous pneumothorax in an HIV-positive patient.

A 31-year-old HIV-positive Hispanic man with a history of intravenous drug abuse was admitted with sudden onset, sharp, bilateral chest pain with shortness of breath. The pain was predominantly in the posterior thorax and was not pleuritic in nature. The patient also reported fevers to 39.0#{176}Cfor two days prior to admission. In the more distant past, the patient described a cough productive ofyellow sputum and a 40.82 kg (90 pound) weight loss over the eight months prior to admission. Physical examination revealed a temperature of 39.3#{176}C, decreased breath sounds at both lung bases, and oral thrush. Laboratory data demonstrated a WBC of4.1K. Arterial blood gas values on room air showed a pH of 7.45, Pco9, 31; Po2, 83; and a 93 percent 02 saturation. A PA view of the chest demonstrates cystic parenchymal changes at the lung bases, greater on the right than left. Ill addition, bilateral apical pneumothoraces are present (Fig 1 and 2). There are no superimposed infiltrates or masses in the lung fields. There is flO evidence ofhilar or mediastinal adenopathy or pleural effusions.