3. Most common AIDS-associated malignancy
Herpes virus
Mostly in homosexual or bisexual men and
their partners
Western countries and Africa
4.
5. Parenchymal nodular or reticular opacities
with predilection towards perihilar mid to
lower zones
Pleural effusion
Mediastinal and/or hilar lymphadenopathy
6. ill-defined parenchymal nodules
Surrounded by a small area of ground-glass
density.
Bilateral perihilar pulmonary infiltrates
Interlobular septal thickening
Lymphadenopathy (50%)
7. Multiple poorly defined radio opaque pulmonary lesion in
patient with bronchial and cutaneous Kaposi's sarcoma.
8. Chest X-rays of three patients with pulmonary KS showing bilateral
paracardiac infiltration. Confluent lesions are most evident in C.
9. HRCT scans of patient with pulmonary KS showing peribronchovascular
thickening and irregular narrowing of the bronchial lumen.
10.
11.
12.
13. Seen most frequently in the non-AIDS
Association with Sjogren’s syndrome and
Systemic lupus erythematosus (SLE)
When occurring in the AIDS population it is
most frequent in children
14.
15. Most commonly a mid and lower zone
reticular or reticulonodular infiltrate.
Neither pleural nor lymph node enlargement
is associated with LIP.
Radiographically indistinguishable from
opportunistic infection, slow progression of
radiological change is suggestive of the
diagnosis
16. features can be non specific
◦ Mid & lower-zone predominant, reticular
or reticulonodular infiltrate
◦ chronic bilateral airspace opacification
17. Features generally tend to be diffuse with
mid lower lobe predominance
Thickening of bronchovascular bundles
Intersitital thickening along lymph
channels
Small but variably sized pulmonary
nodules (can be centrilobular or subpleural,
and often ill defined)
Ground-glass
Scattered thin walled cysts
18.
19.
20.
21.
22.
23. Lymphoma occurs with increased frequency
in AIDS patients.
Mediastinal nodal enlargement
Pleural or pericardial effusions
Pulmonary infiltrate or single, multiple
pulmonary masses
24.
25.
26. Non-Hodgkin's Lymphoma (NHL) accounts
for 90%
Well-defined solitary or multiple
parenchymal nodules are common.
Demonstrate a very short doubling time of
between 4 and 6 weeks mimicking
infection.
Unlike KS, they are often peripheral
27.
28.
29.
30. commonest Iymphoma
neoplasm of young adults
The disease usually arises in lymph nodes,
hilar or mediastinal lymph node enlargement
is seen on the chest X-ray
lymphadenopathy is frequently bilateral it is
often asymmetrical and involves anterior
mediastinum.
Retrosternal nodes may erode the sternum.
31.
32.
33. Involvement of lung parenchyma is seen in about
30%
Spread of disease from hilar lymph nodes
The resulting pulmonary infiltrate may resemble
lymphangitis carcinomatosa.
The pulmonary infiltrate may also appear as
solitary areas of consolidation.
May appear as larger confluent areas or miliary
nodules.
The pulmonary opacities may have an air
bronchogram
Involvement of the bronchial wall
Pleural effusion
34. Malignant proliferation of a specific
lymphoreticular cell
Grading systems
Majority arises within lymph glands (or the
thymus)
37. No convincing evidence showing a significant
rise.
It occurs in smokers
Male preponderance and patients often present
at a younger age and at a later stage.
Tumors are frequently poorly differentiated or
predominantly adenocarcinomas.
Radiographic appearances are similar to ordinary
lung cancer, except that lesions tend to be more
peripheral, with over 90% in the upper lobes.
41. Histiocytic lymphoma. Chest X-ray shows mediastinal
adenopathy, multiple ill-defined pulmonary nodules and a right
pleural effusion.
42. Lymphocytic lymphoma. Chest X-ray shows a large left pleural effusion,
a small right pleural effusion and right paratracheal adenopathy.
43.
44. Pulmonary parenchymal lymphoma (A) Chest radiograph reveals multiple
poorly defined pulmonary nodules without lymphadenopathy. (B) CT image
through the lower lobes shows an air bronchogram in the largest mass
(arrow).
49. HRCT of a patient with pulmonary KS at the level of the main bronchi
shows ground-glass attenuation areas in the posterior regions of both
lungs, which correspond to pulmonary hemorrhage. Peribronchovascular
thickening is observed in the right lung, as well as bilateral pleural
effusion.
Notas do Editor
The incidence now appears to be falling due to the widespread use of antiherpes virus drugs and combination antiretroviral therapy
Pulmonary KS occurs in patients with known cutaneous KS
Pulmonary KS is rare in the absence of cutaneous visceral involvement.
mesenchymal tumour that involves the lymphovascular system
Kaposi's sarcoma is a multicentric disease that frequently involves the skin, lymph nodes, gastrointestinal tract, and lungs. Pulmonary KS in the absence of mucocutaneous involvement is uncommon.
The CD4 cell count in patients with pulmonary KS is usually <100 cells/mm3
Pulmonary KS can affect the lung parenchyma, pleura or trachea, bronchial tree.
When there is pulmonary involvement, disease is usually evident bronchoscopically as distinctive raised erythematous plaques within the airways. If these plaques become sufficiently enlarged they may occlude segmental bronchi resulting in atelectasis.
has two major patterns
linear interstitial nodules
fluffy ill-defined nodules
symmetrical perilymphatic
Peribronchovascular distribution (1-2 mm).
lymphadenopathy is typically of high attenuation
The most frequent chest CT findings are thickening of the peribronchovascular interstitium, particularly in the axial portions; irregular and poorly defined nodules; and interlobular septal thickening. The presence of these findings in patients with AIDS is highly suggestive of KS
A and B.
Pulmonary KS in a 45-year-old man. (a) Chest radiograph shows multiple bilateral ill-defined nodules (arrowheads indicate nodules on the right side). Two indistinct masses (arrows) are identified in the left hemithorax.
(b) High-resolution lung CT scan demonstrates two irregular flame-shaped nodules (white arrows) in the right apex and an ill-defined mass (black arrows) in the left apex. The diagnosis was confirmed with fine-needle aspiration biopsy of the left upper lobe mass.
Thoracic AIDS-related KS in a 45-year-old man.
(a) Chest radiograph demonstrates multiple bilateral 3–5-mm micronodules in a peribronchovascular distribution.
(b) High-resolution lung CT scan shows innumerable bilateral, poorly defined peribronchovascular micronodules, some of which exhibit coalescence.
(c) CT scan (soft-tissue windowing) depicts enlarged lymph nodes in the axillae and mediastinum (thin arrows). Note also the bilateral pleural fluid collections as well as some nodularity (thick arrows). Skin compromise is also identified in the left hemithorax (arrowhead). Histopathologic findings were consistent with KS.
Disseminated AIDS-related KS in a 36-year-old man with thoracic involvement.
(a)Chest radiograph shows ill-defined nodular confluent opacities in the left upper lobe.
(b) Chest CT scan demonstrates multiple nodules around the bronchus for the apicoposterior segment of the left upper lobe (black arrow). Other small nodules are also identified in the posterior segment of the right upper lobe (white arrows).
(B, C). CT scans of two different patients demonstrating multiple poorly defined pulmonary nodules with a mid and lower zone and peribronchovascular predominance.
benign lymphoproliferative disorder characterised by lymphocyte predominant infiltration of the lungs
although adult cases are regularly encountered.
subtype of interstitial lung disease
Although it is
Bronchiectasis may occasionally occur.
but may include
The following features may be seen with LIP on HRCT, but the findings are not exclusive to its diagnosis.
Cysts are usually deep within the lung parenchyma- perivascular or sub pleural- typically a cyst abuts a vessel; size range from 1-30 mm (useful for differentiation between lymphoma or the lung )
Mediastinal lymphadenopathy
Lymphocytic interstitial pneumonia in a 76-year-old woman with Sjögren syndrome. Thin-section (1.5-mm-collimation) CT scan demonstrates several thin-walled cystic airspaces (straight arrows) in the right middle and lower lobes. Thickened bronchovascular bundles (curved arrows).
Thin-section (1-mm-collimation) CT scan through the left upper lobe demonstrates numerous thickened interlobular septa (arrows)
Lymphocytic interstitial pneumonitis. (A) Chest X-ray demonstrating bilateral mid and lower zone 2-5-mm nodules.
(B) Three years later there is an extensive mid and lower zone pulmonary infiltrate.
HRCT scan demonstrating the bronchovascular distribution of confluent infiltrate with more peripheral discrete nodules. Transbronchial biopsy confirmed the diagnosis of lymphocytic interstitial pneumonitis.
58-year-old woman with Sojgren syndrome, persistent dyspnea, and biopsy-proven lymphoid interstitial pneumonia. Unenhanced axial CT image through mid lungs reveals centrilobular ground-glass nodules, finding that develops as consequence of peribronchiolar interstitial inflammation.
71-year-old woman with Sojgren syndrome, chest pain, cough, dyspnea, and biopsy-proven lymphoid interstitial pneumonia (LIP). Contrast-enhanced axial CT image shows both perivascular cysts and lower lobe ground-glass opacities, combination of findings that strongly supports diagnosis of LIP.
73-year-old woman with Sojgren syndrome symptoms, including dyspnea and arthralgias, and biopsy-proven lymphoid interstitial pneumonia (LIP). Contrast-enhanced coronal reformatted image through lungs shows numerous thin-walled cysts mostly located adjacent to blood vessels. These perivascular cysts are identified in most patients with LIP.
Lymphoma, rarely confined to the thorax, is well described in AIDS patients.
probably as a consequence of B-lymphocyte proliferation due to long-term stimulation by the HIV virus, and Epstein-Barr virus infection
There may be atypical mediastinal nodal enlargement
possibly due to the longer life expectancy coupled with the longer latency period required for the development of neoplasms.
and the majority of cases are associated with Epstein-Barr virus.
NHL is typically extranodal and usually disseminated at the time of diagnosis. Thoracic involvement is reported in up to 40%, although subclinical involvement is probably higher.
cavitation is unusual
Lymphoma. Chest X-ray (CXR) on a human immunodeficiency virus patient that presented with multiple lung masses, which grew rapidly mimicking infection.
Note that there is no associated lymphadenopathy. Well-defined solitary or multiple parenchymal nodules CXR are common. A percutaneous biopsy revealed a non-Hodgkin's lymphoma
AIDS-related lymphoma. There is a well-defined mass in the left mid zone. Percutaneous needle biopsy was undertaken to confirm the diagnosis.
AIDS-related lymphoma causing extensive consolidation in the right upper lobe. Infiltration of the left lower lobe in association with a pleural effusion is also evident.
with a peak incidence at 25-29 years of age, and a second, smaller peak at 70-74 years.
It is distinguished from other lymphomas by the presence of Reed-Sternberg cells
CT may identify nodal disease not apparent on the chest X-ray. particularly in the retrosternal and paraspinal regions.
Following treatment by radiotherapy or chemotherapy, lymph node calcification may occur.
CT may identify nodal disease not apparent on the chest X-ray. particularly in the retro-sternal and paraspinal regions.
Hodgkin's disease. Chest X-ray (A) shows right hilar lymphadenopathy and the lateral film (B) shows a large anterior mediastinal lymph node mass.
Hodgkin's disease. CT shows extensive calcification in mediastinal lymph nodes in a patient previously treated for Hodgkin's disease.
Pulmonary involvement may also occur. Usually by direct extension from mediastinal lymph nodes across the pleura.
Lung involvement in the absence of lymphadenopathy is rare if the patient has not already been treated.
Pleural involvement by the disease itself is less common, but is a cause of pleural plaques and effusion.
and may cavitate.
It is usually due to spread of disease from hilar lymph nodes along the peribronchial connective tissue space.
Grading systems that relate the morphology of the tumour to prognosis (i.e. going from less to more aggressive: low grade, intermediate grade and high grade)
Tumour architecture (i.e. follicular (or nodular) and diffuse lymphomas).
Mucosa-associated lymphoid tissue (MALT) within the lung may also give rise to primary non-Hodgkin's lymphoma.
These are usually low-grade B-cell lymphomas and manifest as one or more areas of pulmonary consolidation with or without associated adenopathy.
Classification of these tumours is constantly being revised.
line will give rise to a B-cell, T cell or histiocytic lymphoma.
Progression of disease in the non-hodgkin's group is less orderly with pulmonary and pleural involvement often preceding mediastinal disease.
There is also a greater tendency for the pulmonary infiltrates to travel along fissures and involve the pleura
There is no correlation between stage of disease and CD4 count.
Extensive pleural disease as the sole radiographic manifestation of lung cancer has also been reported .
Lymphoma-Hodgkin's disease
Chest X-ray shows bilateral hilar adenopathy, mediastinal adenopathy, right upper lobe pulmonary shadowing and a right pleural effusion.
(B) Contrast-enhanced CT shows massive anterior mediastinal adenopathy, with direct infiltration of the right upper lobe and a large pleural effusion.
Pulmonary lymphoma. CT shows an irregular soft-tissue mass with an air bronchogram.
Histiocytic lymphoma. Chest X-ray shows mediastinal adenopathy, multiple ill-defined pulmonary nodules and a right pleural effusion.
Lymphocytic lymphoma. Chest X-ray shows a large left pleural effusion, a small right pleural effusion and right paratracheal adenopathy.
NHL in a 23-year-old human immunodeficiency virus female.
The chest radiograph shows multiple well-defined lung nodules within the left lung associated with mediastinal lymphadenopathy. Lymphadenopathy is a less common feature in acquired immunodeficiency disease-related NHL and nodes are rarely significant according to size criteria unlike as in the case shown here, where there is significant lymphadenopathy as confirmed by computed tomography (right upper frame). Magnetic resonance imaging is the imaging of choice to detect vascular encasement
Pulmonary parenchymal lymphoma in a 41-year-old HIV-positive man. He presented with worsening shortness of breath and dry cough. (A) Chest radiograph reveals multiple poorly defined pulmonary nodules without lymphadenopathy. (B) CT image through the lower lobes shows an air bronchogram in the largest mass (arrow). CT-guided biopsy showed malignant large cell lymphoma
AIDS-related lymphoma presenting as lymphadenopathy. (A) Contrast-enhanced CT image at the level of the left and right main pulmonary arteries shows a large mass involving the anterior and middle mediastinal compartments. The mass results in obstruction of the superior vena cava and encasement of the right pulmonary artery.
Lymphocytic interstitial pneumonitis in a human immunodeficiency virus patient. Chest X-ray showing bilateral reticulonodular interstitial infiltrates. Diagnosis was confirmed by a transbronchial biopsy
Lymphocytic interstitial pneumonia (LIP) in a 31-year-old man, CD4 cell count 337 cells/mm3 . He presented with a 1-month history of slurred speech but no respiratory symptoms. Chest radiograph shows diffuse, fine nodular changes, best seen in the lower lobes. Surgical biopsy of the right lower lobe showed a bronchiolocentric lymphoid infiltrate accompanied by lymphocytic infiltrates in the interstitium representing a mixture of B and T cells.
Lung carcinoma in a 46-year-old HIV-positive man, CD4 cell count 343 cells/mm3. He had a history of cigarette smoking. The chest radiograph shows a large, well-defined mass in the right upper lobe, as well as extensive emphysematous changes. Biopsy revealed focally necrotic non-small-cell carcinoma.
High-resolution CT scan of a patient with pulmonary KS at the level of the main bronchi shows ground-glass attenuation areas in the posterior regions of both lungs, which correspond to pulmonary hemorrhage. Peribronchovascular thickening is observed in the right lung, as well as bilateral pleural effusion.
Pneumocystis carinii pneumonia (PCP) in a 31-year-old HIV-positive woman with underlying emphysema. (A) Posteroanterior chest radiograph shows a symmetric, bilateral, perihilar, and basilar distribution of ground-glass opacities and consolidation. The symmetrical distribution is typical of PCP. (B) High-resolution CT (HRCT) image at the level of the bronchus intermedius shows a relatively symmetric distribution of ground-glass opacities, with some areas of more confluent consolidation in the lower lobes. Note extensive underlying emphysema with predominantly paraseptal features.
