Isolated lymphadenopathy on chest radiographs of HIV-infected patients.
OBJECTIVE
To determine the aetiology of isolated intrathoracic lymphadenopathy on chest radiographs of HIV-infected patients.


METHODS
Over a 40 month span in 1990-1993, 18 HIV-infected patients (13 men, 5 women) from our New York City adult HIV outpatient clinic development isolated intrathoracic lymphadenopathy (defined as intrathoracic nodal enlargement without other persistent abnormalities on chest radiographs). Serial chest radiographs (n = 18), CT scans when available (n = 7), and clinical charts (n = 18) were reviewed retrospectively.


RESULTS
Median patient age was 34 (range 25-49) years. The diagnoses associated with adenopathy were Mycobacterium tuberculosis (Mtb) in eight (44%), Mycobacterium avium intracellulare complex (MAC) in four (22%), and Mtb and MAC co-infection in three (17%). Cryptococcal infection, thymic hyperplasia, and spontaneous resolution without diagnosis or treatment occurred in one patient each. In 16 (89%) of the 18 patients, lymphadenopathy was present in more than one nodal station. Enlarged nodes were found in the following sites: paratracheal/tracheobronchial (n = 14), aortopulmonary window (n = 9), hilar (n = 7), anterior mediastinum (n = 3), subcarinal (n = 2), and left paraesophageal (n = 2).


CONCLUSIONS
Mycobacterial infection was the aetiology of isolated intrathoracic lymphadenopathy in 15 of 18 (83%) HIV-infected patients. When an inner city HIV-infected patient presents with isolated intrathoracic lymphadenopathy, we recommend an aggressive work-up for mycobacterial disease.
Haramati
L B
LB
Department of Radiology, Albert Einstein College of Medicine, Jacobi Medical Center, New York 10461, USA.
Choi
Y
Y
Widrow
C A
CA
Austin
J H
JH
D000386:AIDS-Related Complex / Q000150:complications* / Q000000981:diagnostic imaging; D017088:AIDS-Related Opportunistic Infections / Q000150:complications* / Q000000981:diagnostic imaging; D000328:Adult; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D008206:Lymphatic Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000150:complications* / Q000000981:diagnostic imaging; D015269:Mycobacterium avium Complex; D015270:Mycobacterium avium-intracellulare Infection / Q000150:complications / Q000000981:diagnostic imaging; D009169:Mycobacterium tuberculosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014388:Tuberculosis, Lymph Node / Q000150:complications / Q000000981:diagnostic imaging; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000000981:diagnostic imaging