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Differential Diagnosis of Thoracic Disease

The radiographic pattern of disease may indicate the likely diagnosis, especially when correlated with the level of immunosuppression and local frequencies of infections or malignancies. In general, common causes of nodules in the lung in AIDS include pneumocystosis, tuberculosis, cytomegalovirus infection, cryptococcosis, aspergillosis, nocardiosis, Kaposi's sarcoma, and non-Hodgkins lymphoma. Pleural effusions are most commonly caused by bacterial pneumonias, tuberculosis, and Kaposi's sarcoma. Cavitary lung lesions are common in invasive aspergillosis, Pseudomonas infection, nocardiosis, and rhodococcosis. Tuberculosis is more likely to cavitate in earlier stages of AIDS. Less common causes of cavities include cryptococcosis, coccidioidomycosis, and histoplasmosis. Kaposi's sarcoma and non-Hodgkin's lymphoma may occasionally cavitate. Thoracic lymphadenopathy suggests tuberculosis, atypical mycobacteria, cryptococcosis, Kaposi's sarcoma, lymphoma, or bacillary angiomatosis. When bronchoscopy is not available, transthoracic needle biopsy of pulmonary masses or pneumonias has been proposed as an efficient means of diagnosis.

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