.

Fig. 8.8 Hilar and mediastinal lymphadenopathy (A) progressing to diffuse parenchymal nodularity (B) over a 5-day period in this profoundly immunosuppressed patient.

Fig. 8.9 Miliary tuberculosis is characterized by innumerable very small nodules. This condition is seen in AIDS more often than in the normal HIV-negative host, and can result either from "primary" or postprimary progressive tuberculosis.

Imaging Findings

Lobar consolidation in atypical locations may be seen and progression may be unusually rapid (Fig. 8.8). Miliary disease, which ordinarily may result either from primary nonimmune or progressive primary disease, is more common in patients with AIDS than in HIV-negative patients (Fig. 8.9).

Long's comparison of radiographic findings of tuberculosis in Haitians with and without HIV or AIDS shows that a typical reactivation pattern was seen in 80% of HlV-negative patients, 51% of HIV-positive non-AIDS patients, and 20% of AIDS patients. Similarly, a typical "primary" pattern was seen in 80% of AIDS patients, 30% of HIV-positive non-AIDS patients, and 11% of HIV-negative patients.

AIDS-related tuberculosis is an important cause of empyema. Two-thirds of the empyemas treated in surgical units at a Zambian Hospital were from AIDS-related tuberculosis. Pericardial effusions are also common.

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