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Radiologic findings of adult primary immunodeficiency disorders. Contribution of CT.

STUDY OBJECTIVE
We wished to review the chest radiographic and computed tomographic (CT) findings in adults with primary immunodeficiency disorders, and to evaluate the influence of CT on the treatment of these patients.


DESIGN
Retrospective blinded review of radiographs, CT scans, and clinical data.


SETTING
National referral center for immunodeficiency disorders.


PATIENTS
Forty-six chest radiographs and 22 CT examinations of subjects with primary immunodeficiency disorders were independently scored. Nineteen of the subjects who had CT scans had B-cell deficiency, while 3 had T-cell deficiency.


RESULTS
CT-detected bronchiectasis in 15 of 19 subjects with B-cell deficiency, compared with 7 cases detected on chest radiograph. Unsuspected upper lobe bronchiectasis was found on CT in 15 cases. Other CT findings in this group included small nodules in seven subjects, interstitial lines in four, air trapping in seven, ground glass or parenchymal consolidation in nine, evidence of small airways disease in nine, and mucus plugs in four. Two of the three subjects with T-cell disorders showed cavitation and two had unsuspected reactive mediastinal adenopathy. Clinical management appeared to be altered in five subjects with B-cell deficiency by CT findings of severe focal or diffuse bronchiectasis or small airways disease. Additionally, CT localized the bleeding site in three subjects with hemoptysis.


CONCLUSIONS
CT is valuable for detection of bronchiectasis in subjects with B-cell immunodeficiency and may alter treatment of these patients.