Active pulmonary tuberculosis in patients with AIDS: spectrum of radiographic findings (including a normal appearance)

Radiology. 1994 Oct;193(1):115-9. doi: 10.1148/radiology.193.1.7916467.


Purpose: To assess the efficacy of chest radiography in the detection of active pulmonary tuberculosis in patients with acquired immunodeficiency syndrome (AIDS).

Materials and methods: Initial interpretations of chest radiographs of 133 adult patients with AIDS and positive sputum or bronchoalveolar lavage cultures for Mycobacterium tuberculosis were reviewed. Radiographic findings were correlated with CD4 T-cell counts, sputum stains for acid-fast bacilli (AFB), and antituberculous drug sensitivity.

Results: Forty-eight (36%) patients had a primary M tuberculosis pattern, 38 (28%) had a postprimary M tuberculosis pattern, 19 (14%) had normal radiographs, 17 (13%) had atypical infiltrates, seven (5%) had minimal radiographic changes, and four (3%) had a miliary pattern. Normal chest radiographs were seen for 10 (21%) of 48 patients with less than 200 T cells per microliter and one (5%) of 20 patients with more than 200 T cells per microliter. Drug sensitivity and sputum staining for AFB did not correlate with radiographic findings. Overall, 19% of cases had multidrug resistance to antituberculous medications.

Conclusion: Chest radiographs did not suggest active tuberculosis in 43 (32%) of 133 AIDS patients with active pulmonary tuberculosis.

MeSH terms

  • AIDS-Related Opportunistic Infections / diagnostic imaging*
  • AIDS-Related Opportunistic Infections / epidemiology
  • AIDS-Related Opportunistic Infections / microbiology
  • Adult
  • CD4-Positive T-Lymphocytes
  • Female
  • Humans
  • Incidence
  • Leukocyte Count
  • Lung / diagnostic imaging
  • Male
  • Mycobacterium tuberculosis / isolation & purification
  • Radiography
  • Retrospective Studies
  • Sputum / microbiology
  • Tuberculosis, Pulmonary / diagnosis
  • Tuberculosis, Pulmonary / diagnostic imaging*
  • Tuberculosis, Pulmonary / epidemiology