B. Mayor et al., MEDIASTINAL AND HILAR LYMPHADENOPATHY DUE TO PNEUMOCYSTIS-CARINII INFECTION IN AIDS PATIENTS - CT FEATURES, Journal of computer assisted tomography, 18(3), 1994, pp. 408-411
Objective: Extrapulmonary involvement by Pneumocystis carinii (PC) in
acquired immunodeficiency syndrome (AIDS) patients is uncommon. Our pu
rpose is to describe three AIDS patients with low cluster differentiat
ion cell (CD4) counts, who were receiving aerosol pentamidine prophyla
xis, and who had large noncalcified hilar and mediastinal lymphadenopa
thy. Materials and Methods: Chest radiography, CT, and clinical and la
boratory records of three AIDS patients who had radiographic evidence
of mediastinal and hilar lymphadenopathy were retrospectively reviewed
. Results: Symptoms were quite similar in all patients: weight loss, f
ever, cough, and mild dyspnea. Mediastinal and hilar widening was noti
ced on chest radiography. Contrast-enhanced chest CT revealed multiple
noncalcified lymphadenopathy with supracarinal predominance in all ca
ses. Mediastinoscopy with mediastinal and hilar lymph nodes sampling w
as performed in all patients. Histologic examination of the biopsy spe
cimens demonstrated a necrotic foamy tissue without any calcification,
and silver stain coloration showed abundant PC organisms in each case
. Conclusion: In AIDS patients, PC infection should be considered as a
possible cause of noncalcified hilar and mediastinal lymphadenopathy
along with such possibilities as atypical infections and neoplasms, es
pecially in severely immunocompromised hosts (low CD4) with aerosol pe
ntamidine prophylaxis.