CTICasesDisseminated Tuberculosis in an HIV-Positive Patient
Imaging findings
Chest radiograph shows left-sided consolidation, pleural effusions, and bilateral mediastinal widening. Contrast-enhanced CT of the chest, abdomen, and pelvis demonstrates cavitary nodules in the left upper lobe, severe and massive low-attenuation (necrotic) mediastinal, hilar, retroperitoneal, and mesenteric lymphadenopathy, multiple low-attenuation splenic lesions, and marked duodenal wall thickening and inflammation.
Key takeaways
Disseminated tuberculosis (TB) in patients with advanced HIV/AIDS and profound lymphopenia typically presents with atypical features, including a lack of classic upper-lobe cavitating consolidation and the presence of massive, diffusely distributed, low-attenuation necrotic lymphadenopathy throughout the chest and abdomen. Extrapulmonary manifestations can include splenic microabscesses, tuberculous meningitis, and gastrointestinal TB (such as tuberculous duodenitis), which can clinically manifest as gastric outlet obstruction and mimic a neoplastic process.
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