When Kaposi's sarcoma involves the internal organs, the most common sites of involvement are the gastrointestinal tract (heavily weighted toward small bowel), lungs, and lymph nodes. Gastrointestinal disease presents as irregular masses in any viscus, which may produce obstruction, deformity, or hemorrhage. The most frequently involved is the duodenum. Air contrast examinations or sonography of the gastrointestinal tract may reveal submucosal nodules, polypoid lesions, or diffuse thickening and distortion. Larger lesions may have central umbilication, producing a target effect. Hepatosplenomegaly may be present. Lymphadenopathy is also seen (Fig. 8.47 A), which may enhance to some extent with contrast injection. Ascites may be present (Fig. 8.47 B). Bone involvement produces lytic lesions with associated periosteal reaction. Associated marrow involvement may be appreciated on MRI. Kaposi's sarcoma seldom involves the brain (see Chapter 42 on Kaposi Sarcoma).

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Fig. 8.47 A, B. Kaposi's sarcoma in the abdomen in AIDS. (A) Ultrasonography shows a large periportal nodal mass (M) and (B) ascites, which is a frequent finding. A, Aorta; GB, gallbladder; IVC, inferior vena caca. (Courtesy of Dr. William Brandt).

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