Imaging Findings

Thoracic manifestations of Kaposi's sarcoma in severely immunocompromised patients include, most commonly, the development of numerous ill-defined nodules with a basilar predominance which tend to follow the bronchovascular bundles (Fig. 8.45). The nodules may be spiculated in appearance, resulting from tumor involvement of adjacent interlobular septa. Cavitation may rarely occur. As the nodules may be hemorrhagic, they can be surrounded by ill-defined ground-glass densities, which represent bleeding into surrounding lung parenchyma. More severe bleeding may cause frank consolidation. The hemorrhage may clear over time, leading to the false impression that the disease is improving. Pleural effusions are common. There may be lymphadenopathy and this may enhance with contrast injection to some extent in about half of cases, but enhancement is not as dramatic as with bacillary angiomatosis. Nodular lesions in the airways are occasionally visible (Fig. 8.46).

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Fig. 8.45 A-E. Pulmonary Kaposi's sarcoma. This may present as multiple ill-defined nodules (A) which are usually spiculated (B) and often involve the adjacent interlobular septa. (C) Cavitation is uncommon. (D) CT scanning shows the peribronchovascular location. (E) Because the Kaposi's sarcoma nodules are vascular there may be hemorrhage into the lung, causing airspace disease.

Fig. 8.46. Kaposi's sarcoma may produce nodular lesions in the airways which may occasionally be visualized on chest radiographs, as in this tracheal lesion (arrow). Similar nodules may be found in the larynx.

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