Clinical and radiographic predictors of the etiology of computed tomography-diagnosed intrathoracic lymphadenopathy in HIV-infected patients.
In HIV-infected patients with intrathoracic lymphadenopathy, it is not known whether clinical and radiographic findings are useful in predicting a specific diagnosis. We determined the etiology and predictors of the etiology of computed tomography (CT)-diagnosed intrathoracic lymphadenopathy in HIV-infected patients evaluated from June 1993 through April 1999. Multivariate analyses were performed to determine clinical and radiographic predictors of the three most common diagnoses. Of 318 patients, 110 (35%) had lymphadenopathy on chest CT. Among these 110 patients, tuberculosis/nontuberculous mycobacterial disease ( = 31), bacterial pneumonia ( = 26), and lymphoma ( = 21) were the most common diagnoses. Multivariate analysis identified cough and necrosis of lymph nodes on chest CT as independent predictors of tuberculosis/nontuberculous mycobacterial disease. African-American race, symptoms for 1 to 7 days, dyspnea, and presence of airways disease on chest CT were independent predictors of bacterial pneumonia; symptoms for >7 days, absence of cough, and absence of pulmonary nodules on CT independently predicted lymphoma. Intrathoracic lymphadenopathy is a frequent chest CT finding in HIV-infected patients. Opportunistic infections and lymphoma are the most common causes, and specific clinical and radiographic features can suggest these particular diagnoses.
Jasmer
Robert M
RM
Division of Pulmonary and Critical Care Medicine, San Francisco General Hospital Medical Center and University of California, San Francisco, California 94110, USA. rjasmer@itsa.ucsf.edu
Gotway
Michael B
MB
Creasman
Jennifer M
JM
Webb
W Richard
WR
Edinburgh
Keith J
KJ
Huang
Laurence
L
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D016483:Lymphoma, AIDS-Related / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D011020:Pneumonia, Pneumocystis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D012514:Sarcoma, Kaposi / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology; D014057:Tomography, X-Ray Computed; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000209:etiology