대한흉부영상의학회 Weekly Chest Cases

Case No : 515 Date 2007-09-10

Courtesy of Tae Jung Kim, MD, Kyung Won Lee, MD. / Seoul National University Bundang Hospital, Korea.
Age/Sex 57 / M
Chief ComplaintCough and multiple skin lesions for 5 months

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Diagnosis With Brief Discussion

Diagnosis: Kaposi’s sarcoma
Radiologic Findings: Chest radiograph shows multiple ill-defined nodular opacities at both lungs.
Chest CT shows bilateral nodular lesions in flame-shape along the bronchovascular bundles. There are several nodules showing perinodular ground-glass opacity (CT halo sign). The patient was known to be HIV(+) and diagnosed as Kaposi’s sarcoma by skin biopsy.
Brief Review: Kaposi's sarcoma (KS) is a tumor caused by Human herpesvirus 8 (HHV8), also known as Kaposi's sarcoma-associated herpesvirus (KSHV) . It was originally described by Moritz Kaposi, an Austro-Hungarian dermatologist practicing at theUniversity of Vienna in 1872. It became more widely known as one of the AIDS defining illnesses in the 1980s. Radiographic findings in diffuse KS comprise 2 major patterns, ie, linear interstitial nodules and fluffy ill-defined nodules. Coexistence of the 2 patterns is not uncommon. A tendency toward a perihilar distribution has been observed. This reflects the bronchovascular-centric nature of the disease, with characteristic thickening along bronchovascular bundles. The thickening becomes more nodular with tumor progression, with eventual confluence of poorly marginated nodules leading to dense airspace consolidation. The middle and lower portions of the lungs are affected more frequently than the upper zones. Classically, nodules are described as flame-shaped or spiculated. They typically measure 1-2 cm in diameter and frequently number more than 10. Septal lines may be seen as a result of lymphatic obstruction or tumor invasion. In patients with KS, characteristic CT findings correlate with chest radiograph appearances, with bronchial wall thickening, ill-defined nodules, and areas of consolidation in a perihilar bronchocentric distribution. Frequently, the nodules are seen to be surrounded by a ground-glass opacity halo representing localized hemorrhage (CT halo sign). Interlobular septal thickening is a common feature seen on HRCT. Pleural effusions and, less commonly, adenopathy may be identified. Occasionally, patients with pulmonary KS with hemoptysis may present with patchy GGO due to hemorrhage.
References: Fraser RS, Muller NL, Colman N, Pare PD. Diagnosis of disease of the chest, 4th ed. Philadelphia, PA. Saunders, 1999: 1337-1339, 1676-1681.
Keywords: Lung, Malignant tumor, Immunocompromised, HIV infection,

No. of Applicants : 60

▶ Correct Answer : 32/60, 53.3%

- Registrar in Radiology, UHL NHS Trust, UK. A. Donuru
- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Osaka University, Japan Osamu Honda
- Samsung medical center, Korea Young A Bae
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Trakya University Edirne Turkey Armagan Sarac
- Marein Hospital, Hamm, Germany Davis Chiramel
- Gimpo Woori Hospital, Korea Son Youl Lee
- Maimonides Medical Center; Brooklyn, N.Y., U.S.A. Naomi Twersky
- Ewha Womans University MokDong Hospital, Korea Yoo Kyung Kim
- IRSA, La Rochelle, France Denis Chabassiere
- Dept. of radiology, Assam medicalcollege, Assam, India Karunakaran M
- Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Dept. of radiology, Kangbuk samsung medical center, Korea Sun Hee Hur
- Nassau, Bahamas Trupti Dabholkar
- Saint-Etienne, France Antoine Marie
- CHRU Lille hopital calmette, France Toledano Manuel
- IRSA La Rochelle, France Jean-Luc BIGOT
- CHU, Grenoble, France Moroni Anne-Line
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Armed Forces ChunCheon Hospital (AFCC), Korea Chae Hun Lim
- E-Da hospital, Taiwan Yu-Feng Wei
- Kyunghee University Medical Center, Korea Su Youn Sim
- Annecy hospital, France Gilles Genin
- Max Hospital, New Delhi, India Vickrant Malhotra
- Ondokuz Mayis University, Samsun Turkey Cetin Celenk
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- Pittwater Radiology, Australia Julie Arora
- Yongsan Hospital, College of Medicine Chung-Ang University, Korea Jae Seung Seo
- Soonchunhyang University Chunan Hospital, Korea Sang Hyun Park
- Aims, New Delhi, India Ashish Gupta

▶ Correct Answer as Differential Diagnosis : 9/60, 15.0%

- KAUMS, Kashan, Iran Ebrahim Razi
- Dept. of Radiology, Trakya University School of Medicine, Turkey Mustafa Kemal Demir
- Yonsei University Severance hospital, Korea Mi-Jung Lee
- Hospital Sotiria, Athens, Greece Vasilios Tzilas
- Ruby Hall Clinic, Pune, India John Joseph
- Jackson Memorial Hospital, Miami, Florida, USA N.B.S.Mani
- Edirne, Turkey Nermin Tuncbilek
- CHU Grenoble France Pierre Yves Savoye
- Armidale Radiology, Australia Saurabh Khandelwal

▶ Semi-Correct Answer : 14/60, 23.3%

- Medinova Diagnostics, Bheemavaram, AP., India Harsha Vardhan
- Pune, India Rahul Deshmukh
- Asan medical center, Korea Dae Yoon Kim
- Ruby Hall Clinic, Pune, India Nikhil Unune
- Lilavati Hospital, Mumbai, India Mahavir Swami
- Nour El-Islam Radiology Center Egypt .Alexandria Elsayed Mousa
- Asan Medical Center, Korea Eun Jin Chae
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Regional Imaging Riverina, Australia Rashid Hashmi
- EKH-Berlin, Germany Michael Weber
- Vital imaging centre, Mumbai, India Ganesh Agrawal
- Shiga University of Medical, Japan. Norihisa Nitta
- Ultracare Coimbatore, India Debabrata Das
- CHU Grenoble, France Bing Fabrice

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 515 Date 2007-09-10

Discussion

No. of Applicants : 60