Thoracic lymphadenopathy in HIV patients: Spectrum of disease and differential diagnosis

To evaluate the etiology and differential features of intrathoracic lymphad enopathy (LAD) in HIV patients, chest computed tomography (CT) records from an 18-month period were reviewed to identify all HIV-positive patients wit h intrathoracic LAD (nodal size greater than or equal to 1 cm). Medical rec ords were reviewed for the documentation of specific diseases causing LAD a nd the CD4 count at the time of imaging. Of 45 HIV-positive patients with L AD, 40 had specific diagnoses including 22 (55%) infections and 17 (43%) tu mors; one patient had both (3%). Mycobacterial disease accounted for 78% of infections; five eases were secondary to bacterial pneumonia and sepsis. O f tumors, lymphoma (7 cases, 39%) was most common, followed by lung cancer, germ cell tumors, and Kaposi's sarcoma. Mean CD4 cell count in patients wi th tumors was much higher than in patients with infections (314 vs. 62, p < .01). patients with humors were somewhat more likely than patients With in fections to demonstrate axillary adenopathy (29 vs. 5%, p = .068). Cavitary disease was only observed in patients with infections (27%, p < .03). CT a nd clinical findings-may help direct the differential diagnosis of LAD in A IDS, and promote expedient definitive diagnosis and therapy.