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Weekly Chest CasesImaging Conference Cases

Case No : 2

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  • Age/Sex 19 / F
  • Case Title F/19 with coughing and mild fever for 5 days.
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Courtesy
S
Imaging Findings
Initial chest radiograph shows diffuse, poorly defined small nodular opacities in both lungs, focal area of consolidation in RML.
HRCT scan demonstrate peribronchovascular thickening with nodular infiltrates, ill-defined or spiculated bronchocentric nodules and ground-glass opacities.
Follow-up chest radiograph after cessation of immunosuppressive drug reveals much decreased nodular opacities and consolidation.
Past History
F/19 with coughing and mild fever for 5 days.
Renal transplantation two years ago due to chronic renal failure.
Under immunosuppressive therapy with cyclosporin, azathioprine, and prednisolone.

Figs. 1-3: Initial study
Figure 4: One month after cessation of immunosuppressive drugs
Discussion
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.

Kaposi's sarcoma develops rarely in young individuals who have an underlying immunocompromising condition other than AIDS (particularly renal transplantation).
There is strong evidence for an etiologic association with herpesvirus 8 (KS-associated herpes virus, KSHV).
Only early diagnosis followed by immediate reduction or discontinuation of immunosuppression, helps successful oncological treatment.

The characteristic CT manifestation of Kaposi's sarcoma consist of
bronchial wall thickening and multiple bilateral irregular lesions or nodules with poorly defined margins in a predominantly peribronchovascular distribution.
Other parenchymal abnormalities include interlobular septal thickening, mass lesions, and focal areas of consolidation.
Pleural effusions, and hilar or mediastinal lymph node enlargement have each been reported in 10% to 50% of cases.
The CT findings are similar in patients who have and does not have AIDS.
Reference
1. Eberhard OK, Kliem V, Brunkhorst R: Five cases of Kaposi's sarcoma in kidney graft recipients: possible influence of the immunosuppressive therapy. Transplantation 1999 15;67:180-4.
2. Aebischer MC, Zala LB, Braathen LR: Kaposi's sarcoma as manifestation of immunosuppression in organ transplant recipients. Dermatology 1997;195(1):91-2.
3. Toth A, Alfoldy F, Jaray J, Gorog D, Borka P, Fehervari I, Perner F: Disseminated Kaposi sarcoma in immunosuppressed patients.Acta Chir Hung 1995-96;35(1-2):53-62.
4. Sivit CJ, Schwartz AM, Rockoff SD: Kaposi's sarcoma of the lungs in AIDS: radiologic-pathologic analysis. AJR 1987;148:25-28.
5. Wolff SD, Kuhlman JE, Fishman EK. Thoracic Kaposi sarcoma in AIDS: CT findings. J Comput Assist Tomogr 1993;17:60-62.

Keywords
Lung, Malignant tumor,
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