Tuberculous lymphadenitis of the thorax: Comparisons of imaging findings between patients with and those without hiv infection

OBJECTIVE. The purpose of this study was to discern differences in the clinical and radiologic presentations of intrathoracic tuberculous lymphadenitis in adult patients with and those without HIV infection. MATERIALS AND METHODS. Between 2000 and 2010, 66 patients (28 men, 38 women; mean age, 45 ± 13.9 years) were found to have intrathoracic tuberculous lymphadenitis. Of these patients, 17 (26%) (15 men, two women; mean age, 47 ± 9.9 years) were HIV-seropositive. Thoracic CT scans were evaluated for involved lymph node stations, long-axis diameter of involved lymph nodes, presence of central necrosis in enlarged nodes, and other associated findings. RESULTS. In HIV-positive patients, tuberculous lymphadenitis had more multifocal (mean number of involved nodal stations, 8.4 versus 3.6; p < 0.001) nodal involvement, had smaller nodes (mean long-axis diameter, 17 mm versus 21 mm; p = 0.004), and was more frequently associated with lung parenchymal lesions and extrathoracic lymph node and organ involvement (p < 0.05) than in HIV-negative patients. Tuberculous lymphadenitis was the sole manifestation of tuberculous infection in 22 of 49 (45%) HIV-negative patients and in 2 of 17 (12%) HIV-positive patients (p = 0.018). CONCLUSION. Tuberculous lymphadenitis in patients with HIV infection is characterized by multiple-station lymphadenitis with extensive lung parenchymal, extrathoracic lymph node, and extrathoracic organ involvement.