ISOLATED LYMPHADENOPATHY ON CHEST RADIOGRAPHS OF HIV-INFECTED PATIENTS

Aim: To determine the aetiology of isolated intrathoracic lymphadenopa thy on chest radiographs of HIV-infected patients. Patients and Method s: 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 developm ent isolated intrathoracic lymphadenopathy (defined as intrathoracic n odal enlargement without other persistent abnormalities on chest radio graphs), Serial chest radiographs (n = 18), CT scans when available (n = 7), and clinical charts (n = 18) were reviewed retrospectively. Res ults: Median patient age was 34 (range 25-49) years. The diagnoses ass ociated with adenopathy were Mycobacterium tuberculosis (Mtb) in eight (44%), Mycobacterium avium intracellulare complex (MAC) in four (22%) , and Mth and MAC co-infection in three (17%). Cryptococcal infection, thymic hyperplasia, and spontaneous resolution without diagnosis or t reatment 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 medi astinum (n = 3), subcarinal (n = 2), and left paraesophageal (n = 2).C onclusion: Mycobacterial infection was the aetiology of isolated intra thoracic lymphadenopathy in 15 of 18 (83%) HIV-infected patients. When an inner city HIV-infected patient presents with isolated intrathorac ic lymphadenopathy, we recommend an aggressive work-up for mycobacteri al disease.