Miliary tuberculosis and HIV

This is a chest x-ray of an HIV-positive man who presented with breathlessness, cough and fever. It shows widespread reticulonodular shadowing, which is greater in the left lung field than the right. There is also significant enlargement of the left hilar region, suggestive of lymph node involvement (arrowed). These features are consistent with disseminated disease, and would be unusual in a healthy, immunocompetent adult. A diagnosis of tuberculosis was confirmed in this patient. Miliary disease is more common in immunocompromised patients. Also, there may be blurring between primary and post-primary radiological features, such as the combination of hilar lymphadenopathy and upper lobe cavitation.