A 40-year-old seaman presented with malaise, fever, dyspnea and a 10 kg weight loss (15% of body weight over a period of the months). High-resolution computed tomography (CT) images demonstrated diffuse ground glass opacities (GGO) in both lungs. A transbronchial lung biopsy (TBLB) was performed but was complicated by the presence of pneumothorax (Fig. 1A). However, as the size of the biopsy sample was inadequate, PCNB was performed immediately after the TBLB. Under CT guidance with the patient in the supine position, a chest radiologist with 18 months of experience performed percutaneous aspiration with the use of a 22-gauge 15-cm Chiba biopsy needle (InterV; Angiotech, Gainesville, FL). A CT scan showed that the needle was placed into the right lung lesion. The procedure was successful at the first attempt. Just after aspiration, the patient complained of dyspnea and subsequently a tonic-clonic type seizure developed with anisocoric pupil dilation. Brain CT imaging was performed with application of an oxygen mask and showed abnormal air densities in the sulci of both the parietal and occipital lobes (Fig. 1B). Unfortunately, hyperbaric oxygen therapy (HBOT) was not available at that time. The PCNB specimen showed the presence of Pneumocystis carinii organisms, and serum testing was positive for antibodies against human immunodeficiency virus (HIV) and the CD4 cell count was less than 50 cells/mm3. Accordingly, the final diagnosis was acquired immunodeficiency syndrome (AIDS) with Pneumocystis carinii pneumonia. Transthoracic echocardiography (TTE) performed two days later failed to reveal any structural abnormalities that could cause the right-to-left shunt. Despite supportive management and antibiotics, the patient died of pneumonia and sepsis without any improvement in mental status.
High-resolution CT scan demonstrates diffuse ground glass attenuations in both lungs, and small amount of right pneumothorax due to previous transbronchial lung biopsy (A).