CHEST IMAGING: Immunocompromised

Case Author: Maria Shiau, MD, New York University School of Medicine, Langone Medical Center

History

40-year-old man with AIDS, increasing cough, and low-grade fever.

Imaging Findings

Posteroanterior chest radiograph (A) shows multiple bilateral pulmonary nodules and masses. Axial CT images in lung windows (B–E) show a right upper lobe nodule and multiple bilateral consolidative pulmonary masses.

Diagnosis

Lymphoma

Teaching Points

Intrathoracic lymphoma in patients with AIDS is usually extranodal, commonly presenting as wellcircumscribed nodules and masses as large as 5 cm in diameter.

The presence of septal lines and irregularly shaped nodules along the peribronchovascular bundles in patients with AIDS strongly suggests the presence of Kaposi sarcoma.

Non-Hodgkin lymphoma is one of three AIDS-defining malignant conditions and the second most common, occurring in 2–10% of persons with HIV infection.

Lung cancer manifests at an earlier age among persons with HIV infection (mean age, 45 years) than in the general population.

Suggested Readings

Muller NL. High yield imaging: chest. Philadelphia, PA: Saunders Elsevier, 2010:204–205

Silva IS, Muller NL. The teaching files: chest. Philadelphia, PA: Saunders Elsevier, 2010:130–133

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