CHEST IMAGING: Immunocompromised

Case Author: Maria Shiau, MD, New York University School of Medicine, Langone Medical Center

History

47-year-old man with positive HIV status, CD4 lymphocyte count of 500/mL, a painful penile lesion, and right lower quadrant pain.

Imaging Findings

Axial CT image (A) at the level of the aortic arch shows enlarged, necrotic anterior mediastinal lymph nodes and enlarged bilateral axillary nodes. Axial CT image (B) at the level of the pelvis shows a right psoas abscess.

Diagnosis

Tuberculosis

Teaching Points

In patients with decreased CD4 counts, reactivation tuberculosis may present with lower lobe consolidation, pleural effusion, and lymph node enlargement, resembling primary tuberculosis.

Immune reconstitution syndrome in patients with tuberculosis is characterized by marked enlargement of the hilar and mediastinal lymph nodes.

Suggested Readings

Muller NL, Silva IS. High yield imaging: chest. Philadelphia, PA: Saunders Elsevier, 2010:200–203

Silva IS, Muller NL. The teaching files: chest. Philadelphia, PA: Saunders Elsevier, 2010:144–145

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