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Imaging features of Mycobacterium avium-intracellulare complex (MAC) in children with AIDS
M Pursner1, J O Haller, W E Berdon
1State University of New York, Health Science Center at Brooklyn, USA.
Purpose:
The purpose of this paper was to review the imaging features of Mycobacterium avium-intracellulare complex (MAC) in 16 pediatric patients with human immunodeficiency virus (HIV).
Materials And Methods:
We reviewed the pertinent clinical records of 16 children diagnosed with MAC between January 1990 and June 1998. These 16 cases were blood- or biopsy-proven to have MAC infection. Their plain films, abdominal, and chest CT scans were then reviewed and the findings were analyzed with reference to the few reported cases of children with MAC.
Results:
Abdominal findings: all but one had retroperitoneal adenopathy, mesenteric adenopathy or both. Ten patients had hepatomegaly, while nine patients were found to have splenomegaly. Four patients had nonspecific thickened gallbladder wall, while intestinal wall thickening and thickened stomach folds were identified in six of ten patients. Necrotic, fluid-filled nodes were also found. Chest findings included mediastinal adenopathy, cystic/cavitary lesions and bronchiectasis. One patient developed a fistula between the mediastinal lymph nodes, esophagus, and bronchial tree.
Conclusion:
Pediatric patients with HIV who develop MAC infection may present with massive lymph node enlargement. This can occur not only in mesenteric and retroperitoneal nodes but also in hilar and posterior mediastinal nodes as well. As in MTB infection, these nodes can break down with development of fistulous tracts to both esophagus and adjacent lung. The major differential diagnostic consideration besides MTB is lymphoma.
Insights
Mycobacterium avium-intracellulare complex (MAC) in pediatric HIV patients often causes massive lymph node enlargement. Imaging reveals widespread adenopathy, organomegaly, and potential fistulous tract formation, mimicking tuberculosis or lymphoma.
Area of Science:
- Pediatric Radiology
- Infectious Diseases
- Medical Imaging
Background:
- Review of imaging features of Mycobacterium avium-intracellulare complex (MAC) in pediatric patients with human immunodeficiency virus (HIV).
- Analysis of 16 blood- or biopsy-proven MAC infection cases diagnosed between 1990 and 1998.
Observation:
- Abdominal imaging showed retroperitoneal and/or mesenteric adenopathy in most patients.
- Hepatomegaly and splenomegaly were common, with some cases exhibiting gallbladder wall thickening and intestinal/gastric wall thickening.
- Chest imaging revealed mediastinal adenopathy, cystic/cavitary lesions, and bronchiectasis, with one case of fistula formation.
Findings:
- Massive lymph node enlargement in mesenteric, retroperitoneal, hilar, and posterior mediastinal nodes is characteristic of MAC infection in pediatric HIV.
- Lymph node breakdown can lead to fistulous tracts involving the esophagus and bronchial tree.
- Imaging findings necessitate differentiation from tuberculosis and lymphoma.
Implications:
- Radiologists should consider MAC infection in pediatric HIV patients presenting with significant lymphadenopathy and associated organomegaly.
- Understanding these imaging patterns aids in timely diagnosis and management of MAC in immunocompromised children.
- The differential diagnosis should include tuberculosis and lymphoma, especially when fistulous tracts are present.
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