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TB in the upper zones is usually common in HIV seronegative patients who have high CD4 counts and are immunocompetent, therefore it is not surprising that HIV patients with high CD4 counts will have upper lung zone involvement.
His chest x-ray on this admission revealed a large, left-sided pleural effusion along with a small pneumothorax in the left upper lung zone.
On the chest X-ray taken at admission into the hospital, a right lower lung zone infiltrate was detected.
A posteroanterior chest radiograph obtained following treatment demonstrated an irregular opacity in the left upper lung zone (Figure 1).
An aberrant right pulmonary artery arising from the abdominal aorta at the origin of the superior mesenteric artery (SMA) supplying the right lower lung zone was also demonstrated.