Jurnal Radiologi

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\pard\li733\ri0\sl-426\slmult0 \*\tx4986\fs18\cf0\f0\charscalex100 {The British
Journal of Radiology, 72}{ }\fs18\cf0\f0\charscalex100 {(1999), 339^344}\tab
\fs24\cf0\f0\charscalex100 {E}{ }\fs18\cf0\f0\charscalex100 {1999 The British
Institute of Radiology}\par\pard\li733\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li733\ri0\sl-613\slmult0 \fs36\cf0\f0\charscalex100 {Pulmonary
tuberculosis: radiological features in West}\par\pard\li733\ri0\sl-466\slmult0
\fs36\cf0\f0\charscalex100 {Africans coinfected with HIV}\par\pard\li733\ri0\sl-
533\slmult0 \fs16\cf0\f0\charscalex100 {1,2}\fs24\cf0\f0\charscalex100 {S D LAWN,}{
}\fs18\cf0\f0\charscalex100 {MRCP}\fs24\cf0\f0\charscalex100 {,}{\super
\fs16\up4\cf0\f0\charscalex100 {3}}\fs24\cf0\f0\charscalex100 {A J EVANS,}
{ }\fs18\cf0\f0\charscalex100 {MRCP}\fs24\cf0\f0\charscalex100 {,}
{ }\fs18\cf0\f0\charscalex100 {FRCR}\fs24\cf0\f0\charscalex100 {,}{\super
\fs16\up4\cf0\f0\charscalex100 {4}}\fs24\cf0\f0\charscalex100 {P M SEDGWICK,}
{ }\fs18\cf0\f0\charscalex100 {BSc}\par\pard\li773\ri0\sl-333\slmult0
\fs20\cf0\f0\charscalex100 {and}{\super \fs16\up3\cf0\f0\charscalex100
{1}}\fs24\cf0\f0\charscalex100 {J W ACHEAMPONG,}{ }\fs18\cf0\f0\charscalex100
{MD}\fs24\cf0\f0\charscalex100 {,}{ }\fs18\cf0\f0\charscalex100
{FWACP}\par\pard\li733\ri0\sl-346\slmult0 \fs12\cf0\f0\charscalex100
{1}\fs20\cf0\f0\charscalex100 {Department of Medicine, School of Medical Sciences,
University of Science & Technology, Kumasi,}\par\pard\li733\ri0\sl-266\slmult0
\fs20\cf0\f0\charscalex100 {Ghana, West Africa, Departments of}
{ }\fs12\cf0\f0\charscalex100 {2}\fs20\cf0\f0\charscalex100 {Infectious Diseases
and}{ }\fs12\cf0\f0\charscalex100 {4}\fs20\cf0\f0\charscalex100 {Mental Health
Sciences, St George's}\par\pard\li733\ri0\sl-280\slmult0 \fs20\cf0\f0\charscalex100
{Hospital Medical School, Cranmer Terrace, London SW17 0RE and}{\super
\fs12\up3\cf0\f0\charscalex100 {3}}\fs20\cf0\f0\charscalex100 {Department of
Radiology,}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{Nottingham City Hospital NHS Trust, Hucknal Road, Nottingham NG5 1PB,
UK}\par\pard\li1080\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li1080\ri0\sl-280\slmult0
\fs20\cf0\f0\charscalex100 {Abstract.}{ }\fs20\cf0\f0\charscalex100 {A
retrospective study was performed to document and compare the radiological
appear-}\par\pard\li1080\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {ances of
newly diagnosed pulmonary tuberculosis (PTB) in groups of West African patients
with}\par\pard\li1080\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{(}\fs18\cf0\f0\charscalex100 {n}\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {86) and without (}\fs18\cf0\f0\charscalex100
{n}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {106) human
immunode�ciency virus (HIV) coinfection. Analysis of chest}\par\pard\li1080\ri0\sl-
253\slmult0 \*\tx8960\*\tx9213\fs18\cf0\f0\charscalex100 {radiographs showed that
the HIV-positive group had less consolidation (mean 3.1 zones}\tab
\fs18\cf0\f0\charscalex100 {vs}\tab \fs18\cf0\f0\charscalex100
{3.7}\par\pard\li1080\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {zones;}
{ }\fs18\cf0\f0\charscalex100 {p}\fs18\cf0\f0\charscalex100
{,}\fs18\cf0\f0\charscalex100 {0.05), less apical involvement (64.0%}
{ }\fs18\cf0\f0\charscalex100 {vs}{ }\fs18\cf0\f0\charscalex100 {85.5%;}
{,}\fs18\cf0\f0\charscalex100 {0.001), less bronchopulmonary
spread}\par\pard\li1080\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {(27.9%}
{,}\fs18\cf0\f0\charscalex100 {0.001), less volume loss (53.5%}
{,}\fs18\cf0\f0\charscalex100 {0.001) and less pleural
thickening}\par\pard\li1080\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {(46.5%}{
}\fs18\cf0\f0\charscalex100 {vs}{ }\fs18\cf0\f0\charscalex100 {61.3%;}
{,}\fs18\cf0\f0\charscalex100 {0.05) compared with the HIV-negative group. However,
HIV-positive patients}\par\pard\li1080\ri0\sl-253\slmult0
\*\tx5133\*\tx5386\*\tx5946\*\tx9293\fs18\cf0\f0\charscalex100 {more commonly had
pleural e�usions (17.4%}\tab \fs18\cf0\f0\charscalex100 {vs}\tab
\fs18\cf0\f0\charscalex100 {6.6%;}\tab \fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {,}\fs18\cf0\f0\charscalex100 {0.05) and
lymphadenopathy (9.3%}\tab \fs18\cf0\f0\charscalex100 {vs}\par\pard\li1080\ri0\sl-
253\slmult0 \fs20\cf0\f0\charscalex100 {1.9%;}{ }\fs20\cf0\f0\charscalex100
{p}\fs20\cf0\f0\charscalex100 {,}\fs20\cf0\f0\charscalex100 {0.05). Previous
studies on this subject from sub-Saharan Africa have focused either
on}\par\pard\li1080\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {selected patient
groups likely to have more advanced immunos}\fs20\cf0\f0\charscalex100 {uppression
or on smear-positive}\par\pard\li1080\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{cases only, or where there has been only limited radiological documentation. This
study suggests}\par\pard\li1080\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {that
the highly signi�cant di�erences that exist may not be as frequent as previously
shown. The}\par\pard\li1080\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {lower
frequencies of bronchopulmonary pattern of consolidation and pleural thickening in
HIV-}\par\pard\li1080\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {positive
subjects have not previously been documented. The possible reasons for the
altered}\par\pard\li1080\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{radiographic appearance of PTB in HIV positive subjects are
discussed.}\par\pard\sect\sectd\sbknone\cols2\colno1\colw5506\colsr-
0\colno2\colw5586\pard\li933\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li933\ri0\sl-
386\slmult0 \fs20\cf0\f0\charscalex100 {The emergence of the human
immunode�ciency}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{virus (HIV) pandemic is having a profound e�ect}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {on the epidemiology, clinical features,
diagnosis}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {and
management of tuberculosis. The greatest bur-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {den of TB/HIV coinfection is borne by the
people}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {of sub-
Saharan Africa. Studies both from the West}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {and from developing countries have shown
that}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {HIV coinfection
leads to an increased frequency}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {of atypical radiographic features in patients
with}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {PTB, with a
tendency towards the pattern of pri-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {mary disease [1^8]. These features include
an}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {increased
frequency of lymphadenopathy and}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {pleural e�usions, less apical disease and less
cavi-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {tation.
Further studies have described a spectrum}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {of radiographic appearances with atypical
features}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {becoming
more common with greater degrees of}\par\pard\li733\ri0\sl-253\slmult0
\*\tx4546\fs20\cf0\f0\charscalex100 {immunode�ciency as re�ected by
CD4}\fs20\cf0\f0\charscalex100 {+}\tab \fs20\cf0\f0\charscalex100 {T-
cell}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {lymphopenia
[9^11].}\par\pard\li933\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Previous
studies documenting the radiographic}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {features of PTB with HIV coinfection in
Central}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {and East
Africa have focused on patient cohorts}\par\pard\li733\ri0\sl-306\slmult0
\fs16\cf0\f0\charscalex100 {Received 10 September 1998 and in revised form
11}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {November 1998,
accepted 23 November 1998.}\par\pard\li733\ri0\sl-253\slmult0
\fs16\cf0\f0\charscalex100 {Address correspondence to Dr Stephen D Lawn, HIV
&}\par\pard\li733\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {Retrovirology
Branch, Mail-Stop G-19, Centers For}\par\pard\li733\ri0\sl-226\slmult0
\fs16\cf0\f0\charscalex100 {Disease Control & Prevention, 1600 Clifton Road,
NE,}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Atlanta, GA
30333, USA.}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {The British Journal of Radiology, April
1999}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
386\slmult0 \fs20\cf0\f0\charscalex100 {who are more likely to have advanced
immunosup-}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {pression
such as hospital in-patients [4, 7, 8] or}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {those from an AIDS clinic [11]. These studies
may}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {have thereby
overemphasized the overall fre-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {quency of atypical radiological �ndings.
Other}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {studies have
performed only very limited docu-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {mentation of the radiological features
[4^6, 8] or}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {have
excluded patients with smear-negative disease}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {[12] for whom chest radiology is a vital
diagnostic}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {adjunct.
The present study in Ghana, West Africa}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {was therefore undertaken to document in detail
the}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {di�erences in the
radiological features of PTB in}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {HIV-positive and HIV-negative groups of
conse-}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {cutively
diagnosed unselected patients.}\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-466\slmult0 \fs24\cf0\f0\charscalex100
{Method}\par\pard\li200\ri0\sl-333\slmult0 \fs18\cf0\f0\charscalex100 {The study
was conducted at the Chest Clinic of}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {the Komfo Anokye Teaching Hospital in
Kumasi,}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {Ghana, a
country with a high incidence of pulmon-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {ary tuberculosis estimated at 200 cases per 100
000}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {population per
year [13]. It is estimated that in}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {excess of 50% of the adult population are
latently}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {infected
with}{ }\fs20\cf0\f0\charscalex100 {Mycobacterium tuberculosis}
{ }\fs20\cf0\f0\charscalex100 {and thus}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {a large majority of pulmonary tuberculosis is
of}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {the typical post-
primary pattern (Figure 1). The}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {HIV-seroprevalence among patients with
newly}\par\pard\li4040\ri0\sl-426\slmult0 \fs18\cf0\f0\charscalex100
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B49AE7B1451400B45145007FFD9}
}}}}\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn226\cols2\
colno1\colw5320\colsr-0\colno2\colw5773\pard\li733\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
413\slmult0 \fs20\cf0\f0\charscalex100 {diagnosed PTB at this clinic was 23% at the
time of}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {the study
[14].}\par\pard\li933\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {The diagnosis
of pulmonary tuberculosis was}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {made on the basis of clinical history,
physical}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{examination, Ziehl^Neelsen microscopy on three}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {sputum samples and chest radiography.
Suspected}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {cases who
were smear-negative and who did not}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {have a characteristic radiological
appearance}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {received
adequate trials of simple antibiotics and}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {serial chest radiography. In the absence
of}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {improvement, the
patient was treated with speci�c}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {antituberculosis drugs and the diagnosis
con�rmed}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {by a
positive treatment response.}\par\pard\li933\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {90 consecutive HIV-positive patients and
110}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {consecutive HIV-
negative patients with a diagno-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {sis of new pulmonary tuberculosis were
recruited}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{retrospectively from the Chest Clinic and in-}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {patient tuberculosis ward at the Komfo
Anokye}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Teaching
Hospital. All were adults. Those with a}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {history of either previous treatment for
tuberculo-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {sis or of
another respiratory disease were excluded.}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {All patients had been screened with consent
for}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {HIV-1 and HIV-2
antibodies as part of a routine}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {national HIV surveillance using
Wellcozyme}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {enzyme-
linked immunosorbent assay (Murex}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {Diagnostics Limited, Dartford, Kent,
UK).}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Positive
results were con�rmed by SUDS latex-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {agglutination test (Murex Diagnostics
Limited).}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {The
patient records were analysed to con�rm a}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {correct diagnosis of pulmonary tuberculosis,
and}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {the patient age,
sex, duration of symptoms prior}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {to diagnosis, sputum smear and HIV-status
were}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {all
documented.}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-213\slmult0
253\slmult0 \*\tx1573\fs18\cf0\f0\charscalex100 {Figure 1.}\tab
\fs18\cf0\f0\charscalex100 {Chest radiograph of HIV-negative
patient}\par\pard\li733\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {with
pulmonary tuberculosis showing �orid post-}\par\pard\li733\ri0\sl-226\slmult0
\fs16\cf0\f0\charscalex100 {primary pattern of disease involving lung apices
in}\par\pard\li733\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {addition to
marked cavitation, volume loss and}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {pleural thickening.}\par\pard\li733\ri0\sl-
213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-240\slmult0 \fs18\cf0\f0\charscalex100
{340}\par\column\pard\li0\ri0\sl-346\slmult0 \fs18\cf0\f0\charscalex100 {S D Lawn,
A J Evans, P M Sedgwick and J W Acheampong}\par\pard\li386\ri0\sl-213\slmult0
{Posteroanterior chest radiographs of all patients}\par\pard\li186\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {were analysed by both a radiologist and a
chest}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {physician
blinded to the HIV status of the patients.}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {The interpretation of each was reached by
consen-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {sus. In the
absence of consensus, a third radiologist}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {was consulted. For descriptive purposes, the
lung}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {�elds were
divided into six zones by two horizontal}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {lines through the anterior ends of the second
and}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {fourth ribs
anteriorly. The presence of the follow-}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {ing was recorded for each radiograph: the
number}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {and pattern
of zones involved with consolidation;}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {bronchopulmonary pattern of spread; miliary
dis-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {ease;
cavitation together with maximum cavity}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {diameter, cavity wall thickness
(}\fs18\cf0\f0\charscalex100 {.}\fs18\cf0\f0\charscalex100 {2
mm}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {`
thick'')}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {and
presence of air^�uid levels; volume loss;}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {pleural thickening; pleural e�usion; hilar and
med-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {iastinal
lymphadenopathy; bronchopleural �stula;}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {evidence of a primary complex; bronchiectasis
and}\par\pard\li186\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {other coexistent
lung disease.}\par\pard\li386\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Group
statistical comparisons were made using}\par\pard\li186\ri0\sl-280\slmult0
\fs18\cf0\f0\charscalex100 {x}{\super \fs10\up3\cf0\f0\charscalex100
{2}}\fs18\cf0\f0\charscalex100 {test and Fisher's exact test statistics
where}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {appropriate.
Comparison of patient age and cough}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {duration between HIV-positive and
negative}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {groups was
made using a}{ }\fs18\cf0\f0\charscalex100 {t}\fs18\cf0\f0\charscalex100 {-test.
Odds ratios with}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {95%
con�dence intervals were calculated.}\par\pard\li186\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {Statistical signi�cance was taken at}
{�}\fs20\cf0\f0\charscalex100 {0.05.}\par\pard\li186\ri0\sl-306\slmult0
\fs24\cf0\f0\charscalex100 {Results}\par\pard\li186\ri0\sl-333\slmult0
\fs22\cf0\f0\charscalex100 {Patient characteristics}\par\pard\li386\ri0\sl-
346\slmult0 \fs18\cf0\f0\charscalex100 {Satisfactory chest radiographs and
clinical}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {details
were present for 192 (86 HIV-positive and}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {106 HIV-negative) of 200 patients. 75 patients
were}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {female and 117
male, and their average age was}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {35.7 years (SD}\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {12.9). HIV-positive patients
were}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {signi�cantly
younger and 93.0% fell into the 20^}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {49 years old age range compared with 78.3%
of}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {HIV-negative
patients (}\fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {,}\fs18\cf0\f0\charscalex100 {0.01). Females had
a}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {1.4 times greater
HIV-seroprevalence than males}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {(}\fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {,}\fs18\cf0\f0\charscalex100 {0.05). The duration of
symptoms at presenta-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{tion was prolonged (mean 4.6 months; range 0.5^}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {36 months). HIV-positive patients had a
shorter}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {mean delay
in presentation of 4.22 months}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {(SD}\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {3.82) compared with HIV-negative
patients}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {(mean 4.76
months; SD}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {5.01;}
{5}\fs18\cf0\f0\charscalex100 {0.09) (Table 1).}\par\pard\li186\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {Table 2 displays the radiological
comparison of}\par\pard\li186\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {the
two patient groups.}\par\pard\li186\ri0\sl-440\slmult0 \fs22\cf0\f0\charscalex100
{Consolidation}\par\pard\li386\ri0\sl-346\slmult0 \fs18\cf0\f0\charscalex100 {HIV-
positive patients showed consolidation in}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {fewer radiographic zones, with 25.6% having
in-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {volvement of
less than or equal to �ve zones com-}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {pared with 38.7% of HIV-negative
patients}\par\pard\li186\ri0\sl-253\slmult0 \*\tx1253\fs18\cf0\f0\charscalex100
{(OR}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {0.54;}\tab
\fs18\cf0\f0\charscalex100 {p}\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {0.05). The seropositive group,
as}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {illustrated by
Figure 2, less frequently had conso-}\par\pard\li186\ri0\sl-253\slmult0
\*\tx3680\*\tx3920\fs18\cf0\f0\charscalex100 {lidation involving the lung apices
(64%}\tab \fs18\cf0\f0\charscalex100 {vs}\tab \fs18\cf0\f0\charscalex100
{85.5%;}\par\pard\li186\ri0\sl-253\slmult0 \*\tx2773\fs18\cf0\f0\charscalex100
{OR}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {0.29;
CI}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {0.15, 0.59;}\tab
{,}\fs18\cf0\f0\charscalex100 {0.001) although}\par\pard\li1080\ri0\sl-
{The British Journal of Radiology, April 1999}\par\pard\sect\sectd\sbkpage
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}}}}\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn226\cols2\
colno1\colw9066\colsr-0\colno2\colw2026\pard\li733\ri0\sl-346\slmult0
\fs18\cf0\f0\charscalex100 {Pulmonary radiology in TB/HIV
coinfection}\par\pard\li733\ri0\sl-400\slmult0 \*\tx1453\fs18\cf0\f0\charscalex100
{Table 1.}\tab \fs18\cf0\f0\charscalex100 {Characteristics of HIV-positive and
negative groups of patients with pulmonary tuberculosis}\par\pard\li733\ri0\sl-
386\slmult0 \*\tx4773\*\tx6920\fs18\cf0\f0\charscalex100 {Characteristic}\tab
\fs18\cf0\f0\charscalex100 {HIV-pos.}\tab \fs18\cf0\f0\charscalex100 {HIV-
neg.}\par\pard\li4773\ri0\sl-226\slmult0 \*\tx6933\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {86)}\tab \fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {106)}\par\column\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\f0\charscalex100 {p}{ }\fs18\cf0\f0\charscalex100
{value}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133
\cols4\colno1\colw4773\colsr-0\colno2\colw2160\colsr-0\colno3\colw2133\colsr-
0\colno4\colw2026\pard\li733\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {Mean
age (years) (SD)}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {No.
aged 20^49 years (%)}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{No. male (%)}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {No.
female (%)}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Mean (SD)
cough duration (months)}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {No smear positive (%)}\par\pard\li733\ri0\sl-
280\slmult0 \*\tx1040\fs10\cf0\f0\charscalex100 {a}{\sub \fs16\cf0\f0\charscalex100
{x}}\fs10\cf0\f0\charscalex100 {2}\tab \fs16\cf0\f0\charscalex100
{test.}\par\column\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {33.6
(13.8)}\par\pard\li0\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {80
(53.3)}\par\pard\li93\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {4.22
(68.6)}\par\column\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100 {37.5
(46.6)}\par\pard\li80\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {4.76
(74.5)}\par\column\pard\li0\ri0\sl-413\slmult0 \fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {,}\fs18\cf0\f0\charscalex100
{0.05}\par\pard\li0\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {,}\fs18\cf0\f0\charscalex100 {0.01}{\super
\fs12\up3\cf0\f0\charscalex100 {a}}\par\pard\li0\ri0\sl-253\slmult0
{,}\fs18\cf0\f0\charscalex100 {0.05}{\super \fs12\up3\cf0\f0\charscalex100
{a}}\par\pard\li0\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {,}\fs18\cf0\f0\charscalex100 {0.05}{\super
{5}\fs18\cf0\f0\charscalex100 {0.09}\par\pard\li0\ri0\sl-240\slmult0
{.}\fs18\cf0\f0\charscalex100 {0.1}\fs12\cf0\f0\charscalex100
{a}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\col
s2\colno1\colw5506\colsr-0\colno2\colw5586\pard\li733\ri0\sl-213\slmult0
{consolidation a�ected mid and lower zones in the}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {two groups equally.
Bronch}\fs18\cf0\f0\charscalex100 {opulmonary spread}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {pattern of consolidation was less commonly
seen}\par\pard\li733\ri0\sl-253\slmult0
\*\tx4160\*\tx4453\fs20\cf0\f0\charscalex100 {among HIV-positive subjects
(27.9%}\tab \fs20\cf0\f0\charscalex100 {vs}\tab \fs20\cf0\f0\charscalex100
{58.5%;}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{OR}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.27,
CI}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.15, 0.51;}
{,}\fs20\cf0\f0\charscalex100 {0.001).}\par\pard\li733\ri0\sl-213\slmult0
{Cavitation}\par\pard\li933\ri0\sl-346\slmult0 \fs18\cf0\f0\charscalex100 {There
was a statistically insigni�cant trend}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {towards less cavitation in seropositive
subjects}\par\pard\li733\ri0\sl-253\slmult0
\*\tx1493\*\tx1840\fs20\cf0\f0\charscalex100 {(59.3%}\tab
\fs20\cf0\f0\charscalex100 {vs}\tab \fs20\cf0\f0\charscalex100 {71.7%,
OR}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.58;
CI}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.31,
1.05;}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{p}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.07). There was no
signi�cant di�erence seen}\par\pard\li733\ri0\sl-280\slmult0
\*\tx2800\fs20\cf0\f0\charscalex100 {in cavity size (}\fs20\cf0\f0\charscalex100
{p}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.37;}\tab
\fs20\cf0\f0\charscalex100 {x}{\super \fs12\up3\cf0\f0\charscalex100
{2}}\fs20\cf0\f0\charscalex100 {test for trend). Cavity}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {wall thickness could only be determined in
29 of}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {the HIV-
positives and 50 HIV-negative patients}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {and there was no signi�cant di�erence
between}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {the two
groups.}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
320\slmult0 \fs22\cf0\f0\charscalex100 {Other features}\par\pard\li933\ri0\sl-
346\slmult0 \*\tx3040\*\tx3386\fs20\cf0\f0\charscalex100 {Volume loss
(53.5%}\tab \fs20\cf0\f0\charscalex100 {vs}\tab \fs20\cf0\f0\charscalex100 {76.4%;
OR}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100
{0.35;}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{CI}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {0.19, 0.66;}
{5,}\fs20\cf0\f0\charscalex100 {0.001) and pleural
thickening}\par\pard\li733\ri0\sl-253\slmult0
\*\tx1506\*\tx1853\fs18\cf0\f0\charscalex100 {(46.5%}\tab
\fs18\cf0\f0\charscalex100 {vs}\tab \fs18\cf0\f0\charscalex100 {61.3%;
CI}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {0.31,
0.98;}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100
{p}\fs20\cf0\f0\charscalex100 {,}\fs20\cf0\f0\charscalex100 {0.05) were less
commonly seen in HIV-positive}\par\pard\li733\ri0\sl-213\slmult0
\*\tx1546\fs16\cf0\f0\charscalex100 {Figure 2.}\tab \fs16\cf0\f0\charscalex100
{Chest radiograph of an HIV-positive patient}\par\pard\li733\ri0\sl-226\slmult0
\fs16\cf0\f0\charscalex100 {with pulmonary tuberculosis showing hilar
lymphade-}\par\pard\li733\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {nopathy, a
paucity of consolidation in the lower zone,}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {and no volume loss, pleural thickening nor
cavitation.}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {The British Journal of Radiology, April
1999}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
293\slmult0 \fs20\cf0\f0\charscalex100 {patients. Mediastinal and hilar
lymphadenopathy}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {(9.3%}
{ }\fs20\cf0\f0\charscalex100 {vs}{ }\fs20\cf0\f0\charscalex100 {1.9%;
CI}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {1.10, 25.83;}
{,}\fs20\cf0\f0\charscalex100 {0.05)}\par\pard\li0\ri0\sl-253\slmult0
\*\tx2600\*\tx2853\fs20\cf0\f0\charscalex100 {and pleural e�usions (17.4%}\tab
\fs20\cf0\f0\charscalex100 {vs}\tab \fs20\cf0\f0\charscalex100 {6.6%;
OR}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100
{2.99;}\par\pard\li0\ri0\sl-253\slmult0 \*\tx1453\fs20\cf0\f0\charscalex100
{CI}\fs20\cf0\f0\charscalex100 {5}\fs20\cf0\f0\charscalex100 {1.16, 7.71;}\tab
{,}\fs20\cf0\f0\charscalex100 {0.05) were more commonly}\par\pard\li0\ri0\sl-
253\slmult0 \fs20\cf0\f0\charscalex100 {found in HIV-positive patients (Figures 2
and 3),}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {and the
e�usions were more likely to be bilateral.}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {The prevalence of other features including
miliary}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {disease,
evidence of a primary focus, broncho-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {pleural �stula and bronchiectasis all occurred
with}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {a very low
frequency (Table 2).}\par\pard\li0\ri0\sl-213\slmult0
{Discussion}\par\pard\li200\ri0\sl-346\slmult0 \fs20\cf0\f0\charscalex100 {This
study shows that the radiological appear-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {ance of PTB in HIV-negative Ghanaian adults
is}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {predominantly the
characteristic post-primary}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {pattern showing extensive consolidation,
upper}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {lobe
involvement, frequent cavitation and tissue}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {destruction (Figure 1). Late diagnosis in
Kumasi}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {contributes to
the often-advanced radiological}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {extent of disease [15]. This study also
demonstrates}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {that HIV
coinfection leads to multiple, highly sig-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {ni�cant di�erences in the radiological
appearance}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {of PTB. The
low frequencies of bronchopulmonary}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {pattern of consolidation and pleural thickening
in}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li0\ri0\sl-360\slmult0 \*\tx813\fs18\cf0\f0\charscalex100
{Figure 3.}\tab \fs18\cf0\f0\charscalex100 {Chest radiograph of an HIV-positive
patient}\par\pard\li0\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {with pulmonary
tuberculosis showing a right pleural}\par\pard\li0\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {e�usion and hilar
lymphadenopathy.}\par\pard\li4040\ri0\sl-213\slmult0
{341}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\p
ard\sect\sectd\sbkpage
2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;24577;32768}}
{\shp{\*\shpinst\shpleft4800\shptop2093\shpright6640\shpbottom2106\shpfhdr0\shpwr3\
shpwrk0\shpfblwtxt1\shplid2036\shpz1\shpbxpage\shpbypage
2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;24577;32768}}
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shpwrk0\shpfblwtxt1\shplid2037\shpz2\shpbxpage\shpbypage
2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;24577;32768}}
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{\shp{\*\shpinst\shpleft1400\shptop10680\shpright10480\shpbottom10693\shpfhdr0\shpw
r3\shpwrk0\shpfblwtxt1\shplid2039\shpz4\shpbxpage\shpbypage
2;12;16384;45824;1;45824;1;45824;1;45824;1;45824;24577;32768}}
{\sp{\sn fLayoutInCell}{\sv
1}}}}\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\margbsxn226\pard\
li5320\ri0\sl-346\slmult0 \fs18\cf0\f0\charscalex100 {S D Lawn, A J Evans, P M
Sedgwick and J W Acheampong}\par\pard\li733\ri0\sl-440\slmult0
\*\tx1480\fs16\cf0\f0\charscalex100 {Table 2.}\tab \fs16\cf0\f0\charscalex100
{Comparison of radiographic features of pulmonary tuberculosis in HIV-positive and
negative groups of}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{patients}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn
133\cols4\colno1\colw4133\colsr-0\colno2\colw2373\colsr-0\colno3\colw2480\colsr-
0\colno4\colw2106\pard\li733\ri0\sl-386\slmult0 \fs18\cf0\f0\charscalex100
{Characteristic}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
{Consolidation}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Mean
number of zones}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{Absence of consolidation}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Consolidation in}{ }\fs18\cf0\f0\charscalex100
{�}\fs18\cf0\f0\charscalex100 {3 zones}\par\pard\li733\ri0\sl-226\slmult0
\fs16\cf0\f0\charscalex100 {Consolidation in}{ }\fs16\cf0\f0\charscalex100
{�}\fs16\cf0\f0\charscalex100 {5 zones}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Bilateral consolidation}\par\pard\li733\ri0\sl-
266\slmult0 \fs18\cf0\f0\charscalex100 {Zonal distribution}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Lung apices}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Lung lower zones}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Mid & lower zones
only}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{Bronchopulmonary spread}\par\pard\li733\ri0\sl-280\slmult0
\fs18\cf0\f0\charscalex100 {Cavitation}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Cavities present}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Number of cavities}\par\pard\li906\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {0}\par\pard\li906\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {1}\par\pard\li906\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {2^4}\par\pard\li906\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {.}\fs18\cf0\f0\charscalex100 {8}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {Maximum diameter of cavities
(cm)}\par\pard\li906\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{,}\fs18\cf0\f0\charscalex100 {2}\par\pard\li906\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {.}\fs18\cf0\f0\charscalex100 {6}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Air^�uid level}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Cavity wall}{ }\fs18\cf0\f0\charscalex100
{.}\fs18\cf0\f0\charscalex100 {2 mm thick}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Other features}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Volume loss}\par\pard\li733\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {Pleural thickening}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Pleural e�usion}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Bilateral e�usion}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Lymphadenopathy}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Miliary disease}\par\pard\li733\ri0\sl-
226\slmult0 \fs18\cf0\f0\charscalex100 {Bronchopleural
�stula}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Evidence of a
primary focus}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{Bronchiectasis}\par\pard\li733\ri0\sl-280\slmult0
\*\tx1040\fs10\cf0\f0\charscalex100 {a}{\sub \fs16\cf0\f0\charscalex100
{x}}\fs10\cf0\f0\charscalex100 {2}\tab \fs16\cf0\f0\charscalex100 {test for
trend.}\par\column\pard\li0\ri0\sl-386\slmult0 \fs18\cf0\f0\charscalex100 {HIV-pos.
(}\fs18\cf0\f0\charscalex100 {n}\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {86)}\par\pard\li0\ri0\sl-333\slmult0
\*\tx1080\fs18\cf0\f0\charscalex100 {No.}\tab \fs18\cf0\f0\charscalex100
{(%)}\par\pard\li93\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li93\ri0\sl-
386\slmult0 \fs18\cf0\f0\charscalex100 {3.1}\par\pard\li0\ri0\sl-226\slmult0
\*\tx1080\fs18\cf0\f0\charscalex100 {11}\tab \fs18\cf0\f0\charscalex100
{(12.7)}\par\pard\li0\ri0\sl-226\slmult0 \*\tx1080\fs18\cf0\f0\charscalex100
{51}\tab \fs16\cf0\f0\charscalex100 {(59.3)}\par\pard\li0\ri0\sl-226\slmult0
{(27.9)}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
293\slmult0 \*\tx1080\fs18\cf0\f0\charscalex100 {51}\tab \fs18\cf0\f0\charscalex100
{0}\tab \fs18\cf0\f0\charscalex100 {(0)}\par\column\pard\li13\ri0\sl-386\slmult0
\fs18\cf0\f0\charscalex100 {HIV-neg. (}\fs18\cf0\f0\charscalex100
{n}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100
{106)}\par\pard\li13\ri0\sl-333\slmult0 \*\tx1133\fs18\cf0\f0\charscalex100
{No.}\tab \fs16\cf0\f0\charscalex100 {(%)}\par\pard\li93\ri0\sl-213\slmult0
{3.7}\par\pard\li93\ri0\sl-226\slmult0 \*\tx1133\fs18\cf0\f0\charscalex100
{(64.2)}\par\pard\li13\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li13\ri0\sl-
280\slmult0 \*\tx1133\fs18\cf0\f0\charscalex100 {91}\tab \fs16\cf0\f0\charscalex100
{(15.1)}\par\pard\li93\ri0\sl-226\slmult0
{(0)}\par\pard\li93\ri0\sl-226\slmult0 \*\tx1133\fs18\cf0\f0\charscalex100
{0}\tab \fs18\cf0\f0\charscalex100 {(0)}\par\pard\li93\ri0\sl-226\slmult0
{2}\tab \fs18\cf0\f0\charscalex100 {(1.9)}\par\column\pard\li0\ri0\sl-
386\slmult0 \fs18\cf0\f0\charscalex100 {p}{ }\fs18\cf0\f0\charscalex100
{value}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
{,}\fs18\cf0\f0\charscalex100 {0.01}\par\pard\li0\ri0\sl-226\slmult0
{,}\fs18\cf0\f0\charscalex100 {0.05}\par\pard\li0\ri0\sl-226\slmult0
{p}\fs18\cf0\f0\charscalex100 {.}\fs18\cf0\f0\charscalex100
{p}\fs18\cf0\f0\charscalex100 {.}\fs18\cf0\f0\charscalex100
{0.001}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
293\slmult0 \fs18\cf0\f0\charscalex100 {p}\fs18\cf0\f0\charscalex100
{5}\fs18\cf0\f0\charscalex100 {0.076}{\super \fs12\up3\cf0\f0\charscalex100
{a}}\par\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-213\slmult0
{p}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100 {0.37}{\super
{p}\fs18\cf0\f0\charscalex100 {5}\fs18\cf0\f0\charscalex100
{0.05}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\
cols2\colno1\colw5506\colsr-0\colno2\colw5586\pard\li733\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li733\ri0\sl-320\slmult0 \fs20\cf0\f0\charscalex100 {HIV-
positive subjects have not been previously}\par\pard\li733\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {documented.}\par\pard\li933\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {It is likely that the observed radiographic
di�er-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {ences are
predominantly a re�ection of the}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {decreased cell-mediated immunity in patients
with}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {HIV infection,
although the earlier diagnosis of the}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {patients with TB/HIV coinfection (mean of
0.54}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {months earlier)
might have in�uenced the radio-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {graphic presentation to a small extent.
patients with PTB have been found to have}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {reduced enrichment and activation of immune
cells}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {at the site of
mycobacterial infection in the lung,}\par\pard\li733\ri0\sl-253\slmult0
\*\tx3373\fs18\cf0\f0\charscalex100 {leading to a failure of
CD4}\fs18\cf0\f0\charscalex100 {+}\tab \fs18\cf0\f0\charscalex100 {alveolitis [16].
This}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {impairment of
cell-mediated tissue response could}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {explain the relative paucity of
consolidation,}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{pleural thickening and volume loss seen}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {(Figure 2). HIV coinfection of patients
with}\par\pard\li733\ri0\sl-320\slmult0 \fs18\cf0\f0\charscalex100
{342}\par\column\pard\li0\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li0\ri0\sl-
320\slmult0 \fs20\cf0\f0\charscalex100 {tuberculosis has been described as
producing a}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {spectrum
of tissue response according to the}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {degree of immunosuppression similar to the
polar-}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {ized
tuberculoid and lepromatous forms of leprosy.}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {Less cavitation may be a re�ection of poor
cell-}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {mediated
immunity resulting in reduced granu-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {loma formation, caseation and liquefaction
which}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {are the
histopathological processes leading to cavi-}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {tation. The lower frequency of cavitation
among}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {HIV-positive
patients may further explain the}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {reduced frequency of positive sputum smears
and}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {bronchopulmonary
spread in this study. Failure}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {of tissue containment of the disease may lead
to}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {the more frequent
involvement of mediastinal and}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {hilar lymph nodes and occurrence of
pleural}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {e�usions
(Figures 2 and 3). For the same reason,}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {we expected miliary disease to be
signi�cantly}\par\pard\li893\ri0\sl-320\slmult0 \fs16\cf0\f0\charscalex100 {The
British Journal of Radiology, April
1999}\par\pard\sect\sectd\sbknone\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\p
ard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\margtsxn666\
margbsxn226\cols2\colno1\colw5506\colsr-0\colno2\colw5586\pard\li733\ri0\sl-
346\slmult0 \fs18\cf0\f0\charscalex100 {Pulmonary radiology in TB/HIV
coinfection}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
280\slmult0 \fs20\cf0\f0\charscalex100 {more frequent among HIV-positive
patients.}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Previous
studies found higher frequencies of}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {6^8% of PTB being of miliary pattern in
patients [7, 8] which may, in part, re�ect}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {selection of patients with more advanced
immuno-}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {suppression
in those studies.}\par\pard\li933\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100
{Previous studies on this subject in the West have}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {focused on patients with AIDS [1, 2].
Studies from}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {East
and Southern Africa have reported on hospi-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {tal in-patients with a tendency to select
patients}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {with more
advanced immunosuppression [4, 7,}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {8], and others have excluded smear
negative}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {patients
for whom radiological appraisal is a vital}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {part of the diagnosis [12]. Thus, although the
qua-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {litative
radiographic di�erences observed in this}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {study are in broad agreement with previous
stu-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {dies, there are
important di�erences in the fre-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {quency of these features which may be
accounted}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {for by
patient selection in these earlier studies.}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {Reports of HIV-positive patients with PTB
in}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {East and Southern
Africa have shown very high}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {rates of lymphadenopathy (30^50%) [4, 7,
8],}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {pleural e�usions
(30^43%) [4, 7, 8] and miliary}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {consolidation (6^8%) [7, 8] as compared
with}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {9.3%, 4.7% and
2.3%, respectively in this study.}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {Our �gures are more in agreement with
those}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {observed in a
study of unselected patients in the}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {neighbouring West African country of
Cote}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {D'Ivoire [9].
It is likely that these di�erences are}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {largely the result of di�erences in patient
selec-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {tion.
Unfortunately, in nearly all these studies,}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {including our own, the degree of
immunosuppres-}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {sion
of the patients as indicated by CD4 lympho-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {cyte counts was not known. It is likely that
the}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {patients in this
study had a similar spectrum of}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {immunode�ciency as that found in the study
of}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {TB/HIV coinfected
patients in neighboring Cote}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {D'Ivoire in which the percentages of patients
with}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {CD4 counts
greater than 400, 200^400 and less}\par\pard\li733\ri0\sl-280\slmult0
\fs18\cf0\f0\charscalex100 {than 200}\fs18\cf0\f0\charscalex100
{6}\fs18\cf0\f0\charscalex100 {10}{\super \fs10\up3\cf0\f0\charscalex100
{6}}\fs18\cf0\f0\charscalex100 {l}{\super \fs10\up3\cf0\f0\charscalex100
{^1}}\fs18\cf0\f0\charscalex100 {were 27%, 32% and 41%,}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {respectively, at diagnosis [9]. Another
cause for}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {the
di�erences in our results from other studies}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {in sub-Saharan Africa might be racial
variations}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {in host
response to}{ }\fs20\cf0\f0\charscalex100 {M. tuberculosis}
{ }\fs20\cf0\f0\charscalex100 {which have a}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {genotypic basis [17]. However, we disregarded
the}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {occurrence of
HIV-2 in West Africa as a con-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {founding factor as HIV-1 and HIV-2 have
been}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {shown to
produce identical radiological changes}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {in patients with PTB [9] and HIV-2 accounts
for}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {less than 5% of
our HIV-positive patients in}\par\pard\li733\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {Kumasi.}\par\pard\li933\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {In conclusion, this and previous studies
have}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {highlighted
atypical radiological features in PTB}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {associated with HIV infection, although this
study}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {suggests that
patient selection in previous studies}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {may have overemphasized the frequency of
these}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {di�erences.
The chest radiograph remains a useful}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {diagnostic modality for PTB in HIV-
positive}\par\pard\li733\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {The British
Journal of Radiology, April 1999}\par\column\pard\li0\ri0\sl-213\slmult0
\fs20\cf0\f0\charscalex100 {patients, although awareness of the potential
for}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {atypical
presentation is important.}\par\pard\li0\ri0\sl-213\slmult0
{Acknowledgments}\par\pard\li200\ri0\sl-333\slmult0 \fs18\cf0\f0\charscalex100 {The
Tropical Health and Education Trust}\par\pard\li0\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {(THET) of 1 Park Square West, London is
grate-}\par\pard\li0\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {fully
acknowledged for its �nancial assistance.}\par\pard\li0\ri0\sl-213\slmult0
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JOM,}\par\pard\li293\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Zumla A.
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{Tuberculosis Programme in Ghana. Ghana:}\par\pard\li280\ri0\sl-226\slmult0
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{1997;31b:850^4.}\par\pard\li4040\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100
{343}\par\pard\sect\sectd\sbkpage\pgwsxn11893\pghsxn16840\marglsxn666\margrsxn133\m
argtsxn666\margbsxn226\cols2\colno1\colw5320\colsr-
0\colno2\colw5773\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
{15. Lawn SD, A�ul B, Acheampong JW. Pulmonary}\par\pard\li1013\ri0\sl-
226\slmult0 \fs16\cf0\f0\charscalex100 {tuberculosis: diagnostic delay in Ghanaian
adults.}\par\pard\li1013\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Int J
Tuberc Lung Dis 1998;2:635^40.}\par\pard\li733\ri0\sl-226\slmult0
\fs16\cf0\f0\charscalex100 {16. Law KF, Jagirdar J, Weiden MD, Bodkin M,
Rom}\par\pard\li1013\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {WN.
Tuberculosis in HIV-positive patients: cellular}\par\pard\li1013\ri0\sl-226\slmult0
\fs18\cf0\f0\charscalex100 {response and immune activation in the lung.
Am}\par\pard\li1013\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {J Respir Care
Med 1996;153:1377^84.}\par\pard\li733\ri0\sl-586\slmult0 \fs36\cf0\f0\charscalex100
{Book review}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
280\slmult0 \fs20\cf0\f0\charscalex100 {Radiology of Chest Diseases (2nd
edn)}\fs20\cf0\f0\charscalex100 {. By S Lang}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {and G Walsh, pp. x}\fs18\cf0\f0\charscalex100
{+}\fs18\cf0\f0\charscalex100 {372, 1997 (Georg Thieme}\par\pard\li733\ri0\sl-
253\slmult0 \fs20\cf0\f0\charscalex100 {Verlag, Stuttgart), DM
189.00}\par\pard\li733\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {ISBN
0865776377}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {This is a
fully revised second edition, with special}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {emphasis on CT. A chapter on cardiac imaging
has}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {also been added.
The book aims to provide a con-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {cise, easy to use guide to chest radiology. I
believe}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {it is aimed
not just at radiologists but also at inter-}\par\pard\li733\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {ested physicians.}\par\pard\li933\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {Starting with a clear and well illustrated
chapter}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {on
examination techniques, anatomy, physiology}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {and normal radiographic �ndings, it proceeds
to}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {cover the full
range of thoracic disease in the next}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {230 pages. Some chapters are de�ned by
patholo-}\par\pard\li733\ri0\sl-253\slmult0 \*\tx2573\fs18\cf0\f0\charscalex100
{gical processes,}{ }\fs18\cf0\f0\charscalex100 {e.g.}\tab
\fs18\cf0\f0\charscalex100 {chronic obstructive pulmon-}\par\pard\li733\ri0\sl-
253\slmult0 \fs18\cf0\f0\charscalex100 {ary disease, neoplasms of the lung etc.
Others}\par\pard\li733\ri0\sl-253\slmult0 \*\tx4733\fs18\cf0\f0\charscalex100 {deal
with abnormalities on a regional basis,}\tab \fs18\cf0\f0\charscalex100
{e.g.}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {diseases of
the pleura, diseases of the mediastinum.}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {This means that some conditions receive
coverage}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {in more
than one place, although this is often}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {cross-referenced within the text. The �nal
chapter}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {covers
radiographic signs and di�erential diag-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {noses and has an approach based on
radiographic}\par\pard\li733\ri0\sl-253\slmult0 \*\tx2360\fs20\cf0\f0\charscalex100
{appearances,}{ }\fs20\cf0\f0\charscalex100 {e.g.}\tab \fs20\cf0\f0\charscalex100
{lobar and segmental opacities,}\par\pard\li733\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {hilar enlargement, interstitial shadowing
etc.}\par\pard\li933\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {Translation
from the original German text is}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {excellent and the English is easy to read. The
text}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {is generally
well laid out with clear sectional divi-}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {sions and headings. Points of particular note
are}\par\pard\li733\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {in places
highlighted by a pink background;}\par\pard\li733\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {these include both tables of causes or
di�erential}\par\pard\li733\ri0\sl-213\slmult0 \fs18\cf0\par\pard\li733\ri0\sl-
{344}\par\column\pard\li0\ri0\sl-346\slmult0 \fs18\cf0\f0\charscalex100 {S D Lawn,
A J Evans, P M Sedgwick and J W Acheampong}\par\pard\li186\ri0\sl-440\slmult0
\fs16\cf0\f0\charscalex100 {17. Bellamy R, Ruwende C, Corrah T, McAdam
KPJW,}\par\pard\li466\ri0\sl-226\slmult0 \fs16\cf0\f0\charscalex100 {Whittle H,
Hill AVS. Variations in the NRAMP1}\par\pard\li466\ri0\sl-226\slmult0
\fs16\cf0\f0\charscalex100 {gene and susceptibility to tuberculosis in
West}\par\pard\li466\ri0\sl-226\slmult0 \fs18\cf0\f0\charscalex100 {Africans. N
Engl J Med 1998;338:640^4.}\par\pard\li186\ri0\sl-213\slmult0
213\slmult0
266\slmult0 \fs18\cf0\f0\charscalex100 {diagnoses and also sections stating the
goals of}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {diagnostic
imaging. The latter feature seems a par-}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {ticularly good idea, particularly for any
clinicians}\par\pard\li186\ri0\sl-253\slmult0 \fs20\cf0\f0\charscalex100 {who read
the book.}\par\pard\li386\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {The text
is enhanced by a large number of illus-}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {trations, both black and white images and
dia-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {grams. These
are generally of high quality and}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {where necessary small scale }\fs18\cf0\f0\charscalex100
{features are shown to}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {advantage on magni�ed views. The diagrams
are}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {clear and do
much to complement some of the �g-}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {ures and emphasize points made in the text.
There}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {are labelling
errors on a few of the �gures but these}\par\pard\li186\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {are fairly obvious and unlikely to
mislead.}\par\pard\li386\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {The content
of the book is well up-to-date, o�er-}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {ing useful sections on such recent developments
as}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {demonstration of
pulmonary emboli by spiral CT}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {scanning. The sections covering lung, pleural
and}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {mediastinal
diseases are quite comprehensive. The}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {chapter on disorders of the heart will seem
super-}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {�cial to
those with interest in cardiac disease. It}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {gives adequate coverage, however, of
common}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {conditions
and should su�ce for the non-cardiac}\par\pard\li186\ri0\sl-253\slmult0
\fs20\cf0\f0\charscalex100 {specialist.}\par\pard\li386\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {The price of 189 Deutschmarks is
currently}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {equivalent
to approximately �60^�70. It o�ers}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {good value for this and would be a suitable
buy}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {for both
radiology departments and hospital}\par\pard\li186\ri0\sl-253\slmult0
\fs18\cf0\f0\charscalex100 {libraries. It should also be seriously
considered}\par\pard\li186\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {for
purchase by radiologists or physicians with an}\par\pard\li186\ri0\sl-
253\slmult0 \fs20\cf0\f0\charscalex100 {interest in chest
disease.}\par\pard\li3693\ri0\sl-253\slmult0 \fs18\cf0\f0\charscalex100 {J M
B}\fs12\cf0\f0\charscalex100 {ELL}\par\pard\li1080\ri0\sl-213\slmult0
\fs18\cf0\par\pard\li1080\ri0\sl-373\slmult0 \fs16\cf0\f0\charscalex100 {The
British Journal of Radiology, April 1999}\par}

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