What is the role of chest radiography in the workup of severe combined immunodeficiency (SCID)?

Updated: May 27, 2020
  • Author: Francisco J Hernandez-Ilizaliturri, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Sometimes, recurrent or chronic infections may lead to abnormal chest radiographic findings, such as interstitial infiltrates, bronchiectasisemphysema, and scarring. Note: Normal chest radiographic findings do not exclude the presence of structural abnormalities.

Absence of a thymic shadow is a very common finding in SCID. Patients with DiGeorge syndrome and other T-cell defects may also lack thymic tissue. However, the presence of thymic tissue does not exclude SCID. For example, patients with SCID who have mutations in ZAP70 or CD3 typically have normal-sized thymuses.

Chest radiographs in patients with ADA deficiency typically show inferior scapular angle squaring and spurring and costochondral cupping. Verhagen et al reported that these findings can reliably differentiate ADA deficiency from other forms of SCID, in children younger than approximately 7 months of age. [21]


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