Detection and significance of splenomegaly on chest radiographs of HIV-infected outpatients

Aim: The purpose of this study was to determine the prevalence of splenomegaly on chest radiographs of HIV-infected outpatients and to correlate with CD4 cell counts, opportunistic conditions, liver disease and the presence of intrathoracic disease on chest radiographs. Methods: We reviewed sequential chest radiographs of 200 HIV Clinic outpatients at the Jacobi Medical Center, Bronx, New York, mixed with chest radiographs of 137 outpatients of unknown HIV status (control group) for the presence of splenomegaly and intrathoracic disease. Chest radiographic assessment of splenomegaly was correlated with computed tomography (CT) or ultrasound (US) in 90 out of 337 patients (27%). Clinical charts of all HIV-infected patients were reviewed for CD4 cell count, liver disease and opportunistic conditions including those associated with splenomegaly. The HIV-infected patients were divided into four groups by ascending CD4 cell count: Group 1 (0-50 cells/mm³), Group 2 (51-200 cells/mm³), Group 3 (201-500 cells/mm³) and Group 4 (> 500 cells/mm³). There were 118 men and 82 women with a mean age of 40 (range 20-60) years. Mean CD4 was 180 (range 2-1108) cells/mm³. We also reviewed all autopsies (n = 239) performed on HIV-infected patients between 1983 and 1995 at our institution to correlate splenic size with splenic pathology in that population. Results: Splenomegaly was present on chest radiographs in 82 (41%) HIV-infected patients including: 36/84 (43%) Group 1, 23/49 (47%) Group 2, 18/46 (39%) Group 3, and 5/21 (24%) Group 4 (P = NS). Splenomegaly was present in 30/97 (31%) patients with no evidence of liver disease or opportunistic conditions known to be associated with splenomegaly. Forty-nine HIV-infected patients had 63 opportunistic conditions known to be associated with splenomegaly (mycobacterial and fungal infections, Kaposi sarcoma and lymphoma), half of whom had splenomegaly. Splenomegaly was present on chest radiographs in 18/137 (13%) controls. The presence or absence of splenomegaly on CT or US agreed with chest radiography in 89%. Among the autopsied patients, 135/239 (56%) had splenomegaly (splenic weight ≥ 240 g). No specific pathogen was present in 93/135 (69%) enlarged spleens. In contrast, one or more opportunistic conditions were present in 26/104 (25%) normal weight spleens. Conclusion: In conclusion, splenomegaly is common in HIV-infected patients and was present in 41% of this series. Splenomegaly may be seen in HIV-infected patients without associated opportunistic conditions or liver disease and in the absence of specific splenic pathology. Chest radiography plays an important role in detecting splenomegaly and may lead to earlier diagnosis of HIV infection.