Miliary tuberculosis: a comparison of CT findings in HIV-seropositive and HIV-seronegative patients

Abstract

The aim of this study was to determine the differences in CT findings of miliary tuberculosis in patients with and without HIV infection. Two radiologists reviewed retrospectively the CT findings of 15 HIV-seropositive and 14 HIV-seronegative patients with miliary tuberculosis. The decisions on the findings were reached by consensus. Statistical analysis was performed using the chi2 test, Mann-Whitney U-test and Fisher's exact test. All of the HIV-seropositive and -seronegative patients had small nodules and micronodules distributed randomly throughout both lungs. HIV-seropositive patients had a higher prevalence of interlobular septal thickening (p = 0.017), necrotic lymph nodes (p = 0.005) and extrathoracic involvement (p = 0.040). The seropositive patients had a lower prevalence of large nodules (p = 0.031). In conclusion, recognition of the differences in the radiological findings between HIV-seropositive and -seronegative patients may help in the establishment of an earlier diagnosis of immune status in patients with miliary tuberculosis.

Figure 1

Miliary tuberculosis in a 33-year-old woman not infected with HIV. A lung window of a transverse thin-section CT (1.0 mm section thickness) scan obtained at the level of the left upper lobar bronchus shows uniform-sized small nodules and micronodules randomly distributed throughout both lungs. Also note the subpleural and subfissural micronodules (arrows).

Figure 2

Miliary tuberculosis presenting as acute respiratory distress syndrome in a 45-year-old man not infected with HIV. (a) A lung window of a transverse thin-section CT (1.0 mm section thickness) scan obtained at the level of the inferior pulmonary vein shows randomly distributed small nodules and micronodules with bilateral extensive ground-glass attenuation in both lungs. Also note the interlobular septal thickening (arrows) and intralobular interstitial thickening in both lungs. (b) A photomicrograph of a pathological specimen (haematoxylin and eosin staining; original magnification ×400) obtained with a transbronchial lung biopsy demonstrates poorly formed granulomas (arrows) in the alveolar wall and diffuse alveolar wall thickening and intra-alveolar fibrin deposition (arrowheads), suggesting an early stage of diffuse alveolar damage.

Figure 3

Miliary tuberculosis with extrathoracic involvement in a 44-year-old man infected with HIV. (a) A lung window of a transverse thin-section CT (1.0 mm section thickness) scan obtained at the level of the aortic arch shows randomly distributed small nodules and micronodules in both lungs. Also note the peribronchovascular interstitial (arrow) and interlobular septal (arrowhead) thickening. (b) A mediastinal window of a transverse contrast-enhanced CT (5.0 mm section thickness) scan at the level of the coeliac axis shows enlarged lymph nodes (arrows) with central low attenuation and peripheral rim enhancement around the coeliac axis, suggesting tuberculous lymphadenitis. Also note the multiple low attenuation nodules (arrowheads) in the spleen.