Intrathoracic Kaposi's sarcoma in women with AIDS

Study objective: To describe the radiographic features of intrathoracic Kaposi's sarcoma in women with AIDS. Subjects and methods: From 1987 to 1998, we identified seven women with biopsy-proven (n = 4) or autopsy-proven (n = 3) pulmonary Kaposi's sarcoma. Charts were reviewed for HIV risk factors, cutaneous and/or oropharyngeal Kaposi's sarcoma, CD4 cell count, and differential diagnosis of pulmonary disease prior to the diagnosis of pulmonary Kaposi's sarcoma. Chest radiographs (n = 6), chest CT scans (n = 3), and reports of unavailable chest radiograph (n = 1) closest to the time of diagnosis of pulmonary Kaposi's sarcoma were reviewed for the following: nodular and peribronchovascular opacities; thickened interlobular septa; pleural effusions; lymphadenopathy; and radiographic stage. Results: Mean patient age was 33 years (range, 27 to 42 years). HIV risk factors were IV drug use (n = 2), heterosexual contact (n = 3), and both (n = 2). All patients had prior opportunistic infections. The median CD4 cell count was 18/μL (mean, 63/μL; range, 5 to 210/μL). Cutaneous Kaposi's sarcoma was diagnosed prior to pulmonary Kaposi's sarcoma in four patients, subsequently in two patients, and not identified in one patient. Oropharyngeal Kaposi's sarcoma was diagnosed prior to pulmonary Kaposi's sarcoma in three patients. Only infection was considered in the differential diagnosis of the patients' pulmonary disease in five patients. One patient presented with acute hemoptysis and died, and one patient recently received a diagnosis of pulmonary Karposi's sarcoma at another hospital. Chest radiographic findings were the following: nodular opacities in five of seven patients (71%); peribronchovascular opacities in six of seven patients (86%); thickened interlobular septa in two of seven patients (29%); pleural effusion in three of seven patients (43%); and lymphadenopathy in two of seven patients (29%). Five of seven patients (71%) were determined to be in radiographic stage 3, one patient in stage 1, and one patient in stage 2. CT demonstrated additional lymphadenopathy in three of three patients, thickened interlobular septa in two of three patients, and pleural effusion in one of three patients, but it did not change the staging of disease in any patient. Conclusion: Pulmonary Kaposi's sarcoma can cause diffuse lung disease in women with AIDS. The disease is usually mistaken clinically for pulmonary infection.