Intrathoracic adenopathy: differential feature of AIDS and diffuse lymphadenopathy syndrome

The presence of mediastinal and/or hilar adenopathy was assessed from the chest radiographs of two groups of homosexual men: 30 with diffuse, persistent lymphadenopathy syndrome and 45 with acquired immunodeficiency syndrome (AIDS). Intrathoracic adenopathy was not seen on the chest radiographs of the 30 men having diffuse, persistent lymphadenopathy and is therefore not a manifestation of that syndrome. Nine of the 45 men with AIDS demonstrated intrathoracic adenopathy. In each instance, adenopathy was indicative of serious intrathoracic disease. Seven of the nine had minimal or no respiratory symptoms. In four of the nine, the intrathoracic adenopathy detected from the chest radiographs was the first indication of AIDS. In six of the nine patients, one or more opportunistic infections were diagnosed from material obtained at bronchoscopy. Two patients had Hodgkin disease, diagnosed by lymph-node biopsy. The ninth patient, who died, had an immunoblastic sarcoma. Mediastinal and/or hilar adenopathy in patients with AIDS, or in patients at high risk for AIDS, necessitates immediate investigation, including bronchoscopy or lymph-node biopsy.