PERCUTANEOUS NEEDLE LUNG ASPIRATION FOR DIAGNOSING PNEUMONITIS IN THE PATIENT WITH ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS)

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Abstract
Patients (14) with acquired immunodeficiency syndrome (AIDS) or suspected AIDS underwent percutaneous needle lung aspiration (PNLA) for evaluation of 16 occurrences of acute pneumonitis. A 22-gauge spinal needle was passed 2-3 times in the area of greatest radiographic involvement under fluoroscopic guidance. The specimen was immediately placed on microscope slides for Gomori''s methenamine Ag and Papanicolaou staining. The needle then flushed with sterile water for bacterial, Legionella, viral, mycobacterial and fungal cultures, and for Legionelia immunofluorescent staining. Diagnostic information was provided by 14 of the 16 procedures. Of 11 patients ultimately found to have Pneumocystis carinii pneumonitis, PNLA specimens were diagnostic in 10 (91%). Infectious agents other than P. carinii also were identified by PNLA, including cytomegalovirus (4 cases). Mycobacterium avium-intracellulare (1 case) and pyogenic bacteria (3 cases). Complications of PNLA were: pneumothorax in 7 cases (44%), 3 (19%) of which required chest tube evacuation; and minor hemoptysis (< 50 ml) in 2. The PNLA can be a useful diagnostic procedure in the patient with AIDS and pneumonitis. It has the advantages of being less costly and time-consuming than fiberoptic bronchoscopy. It is, frequently complicated by pneumothorax, making it an inappropriate approach for patients with significant respiraotry compromise.