INTRATHORACIC ADENOPATHY ASSOCIATED WITH PULMONARY TUBERCULOSIS IN PATIENTS WITH HUMAN-IMMUNODEFICIENCY-VIRUS INFECTION

The role of computed tomography (CT) in the diagnosis of mediastinal t uberculous lymphadenitis was evaluated retrospectively in 25 human imm unodeficiency virus (HIV)-infected patients (19 had AIDS). In all case s, the diagnosis of tuberculosis was established by mycobacterial cult ure and/or histologic evaluation. The most characteristic CT finding w as the presence of low-density mediastinal and hilar lymph nodes in 16 of 19 (84 percent) patients with AIDS and four of six (67 percent) HI V-seropositive patients without AIDS. Marked enhancement of the periph ery of nodes was identified in five cases, all in patients with docume nted AIDS. In most cases, lymphadenopathy proved to be massive, presen ting as extensive, heterogenous soft-tissue lesions, presumably the re sult of coalescence of groups of matted nodes. We conclude that low-de nsity mediastinal and/or hilar lymph nodes on CT, while not pathognomo nic, is sufficiently characteristic for tuberculosis to warrant empiri c antituberculosis therapy pending results of cultures.