대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Kaposi’s sarcoma

Radiologic Findings

Fig 1. Chest PA shows suspicious pulmonary nodular lesions in both lungs.
Fig 2-5. CT scans reveal multifocal peribronchiolar nodules in both lungs.
Fig 6. FDG-PET scan shows mild FDG-uptake in these nodules.

Brief Review

Kaposi sarcoma (KS) was first reported by Mortiz Kaposi in 1872 (1). KS is a low-grade mesenchymal tumor involving blood and lymphatic vessels. KS usually involves the skin and can manifest as disseminated disease in a variable organ. Human Herpes Virus type 8 (HHV8) and other cofactors have been linked to the development of KS and known as causative agent (2, 3). In this case, HHV8 was also positive. The development of neoplasms is a well-recognized complication after solid-organ transplantation but remains extremely rare after lung transplantation (4). The first Kaposi sarcoma case associated with lung transplantation was reported in 1997 (5). The literature is also scarce in reporting radiographic and CT findings of lung-transplant-related KS (4).
In the setting of AIDS, KS typically presents in the conventional radiograph as middle/lower zone reticular opacities and parenchymal nodules with bronchovascular distribution that may progress to consolidation, interstitial thickening, pleural collections, and hilar and/or mediastinal lymphadenopathies (2). A characteristic CT finding is bilateral and symmetric ill-defined nodules showing peribronchovascular distribution, the so-called flame-shaped nodule (2). Reported radiographic findings of KS after lung transplantation included bilateral lung nodules, mediastinal lymphadenopathy, pleural effusions, and uptake of [F18] FDG of mediastinal lymphadenopathy and pulmonary nodules (4).

References

1. Karamanou M, Antoniou C, Stratigos AJ, Saridaki Z, Androutsos G. The eminent dermatologist Moriz Kaposi (1837-1902) and the first description of idiopathic multiple pigmented sarcoma of the skin. J BUON 2013;18(4):1101-1105.
2. Restrepo CS, Martinez S, Lemos JA, Carrillo JA, Lemos DF, Ojeda P, Koshy P. Imaging manifestations of Kaposi sarcoma. Radiographics 2006;26(4):1169-1185. doi: 10.1148/rg.264055129
3. Galluzzo Mutti L, Alvarez M, Siminovich M, Perez C, Lucero B, Nieto M, Castanos C, Haag D, Boglione M. Disseminated visceral Kaposi s sarcoma in a pediatric bilateral lung transplant recipient. Pediatr Transplant 2019;23(1):e13311. doi: 10.1111/petr.13311
4. Martinez S, McAdams HP, Youens KE. Kaposi sarcoma after bilateral lung transplantation. J Thorac Imaging 2008;23(1):50-53. doi: 10.1097/RTI.0b013e3181585bc4
5. Sleiman C, Mal H, Roue C, Groussard O, Baldeyrou P, Olivier P, Fournier M, Pariente R. Bronchial Kaposi's sarcoma after single lung transplantation. Eur Respir J 1997;10(5):1181-1183. doi: 10.1183/09031936.97.10051181

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