Diagnosis: Kaposi's sarcoma (autopsy-proven)

Radiologic Findings

Chest radiograph shows nodular and linear infiltrates with a perihilar and basal distribution. There are bilateral small pleural effusions.
HRCT scan shows bilateral nodular or flame-shaped lesions along bronchovascular bundles. CT scan viewed at mediastinal windows shows bilateral pleural effusions and enlargement of subcarinal lymph node.

Brief Review

Kaposi's sarcoma is the most common malignancy in AIDS patients, and cutaneous Kaposi's sarcoma is frequently the initial manifestation of the disease. Disseminated Kaposi's sarcoma may involve any organ system, including the lung, but the gastrointestinal tract and lymph nodes are the most frequently affected. The presence of cutaneous Kaposi's sarcoma is an important pointer to the possibility of pulmonary involvement. It appears that pulmonary Kaposi's sarcoma is rare in the absence of cutaneous involvement. Another clinical pointer is the occurrence of hemoptysis.
There is a tendency to perihilar predominance, reflecting a bronchocentric distribution of the lesion (1). The pulmonary infiltrates of Kaposi's sarcoma are not subject to significant day-to-day fluctuations in severity as may be the case with pulmonary edema or the pulmonary opportunistic infections. Pleural involvement by Kaposi's sarcoma is common. Effusions are most often bilateral and may be large. On CT, pulmonary parenchymal disease is characterized by multiple, bilateral flame-shaped or nodular lesions with ill-defined margins distributed along bronchovascular bundles (2).

References

1. Sivit CJ, Schwartz AM, Rockoff SD. Kaposi's sarcoma of the lungs in AIDS: radiologic-pathologic analysis. AJR 1987;148:25-28.
2. Wolff SD, Kuhlman JE, Fishman EK. Thoracic Kaposi sarcoma in AIDS: CT findings. J Comput Assist Tomogr 1993;17:60-62.