Non infectious lung diseases in AIDS

Dr.Aftab Qadir

Kaposi sarcoma Lymphocytic interstitial Pneumonitis Lymphoma

Most common AIDS-associated malignancy Herpes virus Mostly in homosexual or bisexual men and

their partners Western countries and Africa

1.Kaposi sarcoma

Parenchymal nodular or reticular opacities with predilection towards perihilar mid to lower zones

Pleural effusion Mediastinal and/or hilar lymphadenopathy

Chest radiograph

ill-defined parenchymal nodules Surrounded by a small area of ground-

glass density. Bilateral perihilar pulmonary infiltrates Interlobular septal thickening Lymphadenopathy (50%)  

HRCT chest

Multiple poorly defined radio opaque pulmonary lesion in patient with bronchial and cutaneous Kaposi's sarcoma.

Chest X-rays of three patients with pulmonary KS showing bilateral paracardiac infiltration. Confluent lesions are most evident in C.

HRCT scans of patient with pulmonary KS showing peribronchovascular thickening and irregular narrowing of the bronchial lumen.

Seen most frequently in the non-AIDS Association with Sjogren’s syndrome and

Systemic lupus erythematosus (SLE) When occurring in the AIDS population it is

most frequent in children

2.lymphocytic interstitial pneumonitis

Most commonly a mid and lower zone reticular or reticulonodular infiltrate.

Neither pleural nor lymph node enlargement is associated with LIP.

Radiographically indistinguishable from opportunistic infection, slow progression of radiological change is suggestive of the diagnosis

features can be non specific◦Mid & lower-zone predominant, reticular

or reticulonodular infiltrate◦chronic bilateral airspace opacification

Chest radiograph

Features generally tend to be diffuse with mid lower lobe predominance 

Thickening of bronchovascular bundles Intersitital thickening along lymph

channels  Small but variably sized pulmonary

nodules (can be centrilobular or subpleural, and often ill defined)

Ground-glass Scattered thin walled cysts

HRCT

Lymphoma occurs with increased frequency in AIDS patients.

Mediastinal nodal enlargement Pleural or pericardial effusions Pulmonary infiltrate or single, multiple

pulmonary masses

3.Lymphoma

Non-Hodgkin's Lymphoma (NHL) accounts for 90%

Well-defined solitary or multiple parenchymal nodules are common.

Demonstrate a very short doubling time of between 4 and 6 weeks mimicking infection.

Unlike KS, they are often peripheral

commonest Iymphoma neoplasm of young adults The disease usually arises in lymph nodes,

hilar or mediastinal lymph node enlargement is seen on the chest X-ray

lymphadenopathy is frequently bilateral it is often asymmetrical and involves anterior mediastinum.

Retrosternal nodes may erode the sternum.

HODGKIN'S DISEASE

Involvement of lung parenchyma is seen in about 30% Spread of disease from hilar lymph nodes The resulting pulmonary infiltrate may resemble

lymphangitis carcinomatosa. The pulmonary infiltrate may also appear as solitary

areas of consolidation. May appear as larger confluent areas or miliary

nodules. The pulmonary opacities may have an air

bronchogram Involvement of the bronchial wall Pleural effusion

Malignant proliferation of a specific lymphoreticular cell

Grading systems Majority arises within lymph glands (or the

thymus)

NON-HODGKIN'S LYMPHOMA

Radiographic manifestations of non-Hodgkin and Hodgkin's lymphomas are similar.

No convincing evidence showing a significant rise.  

It occurs in smokers Male preponderance and patients often

present at a younger age and at a later stage.   Tumors are frequently poorly differentiated or

predominantly adenocarcinomas.  Radiographic appearances are similar to

ordinary lung cancer, except that lesions tend to be more peripheral, with over 90% in the upper lobes.  

Lung Carcinoma 

Few cases

Pulmonary lymphoma. CT shows an irregular soft-tissue mass with an air bronchogram.

Histiocytic lymphoma. Chest X-ray shows mediastinal adenopathy, multiple ill-defined pulmonary nodules and a right pleural effusion.

Lymphocytic lymphoma. Chest X-ray shows a large left pleural effusion, a small right pleural effusion and right paratracheal adenopathy.

Pulmonary parenchymal lymphoma (A) Chest radiograph reveals multiple poorly defined pulmonary nodules without lymphadenopathy. (B) CT image through the lower lobes shows an air bronchogram in the largest mass (arrow).

LIP:Chest X-ray showing bilateral reticulonodular interstitial infiltrates.

Lymphocytic interstitial pneumonia -Chest radiograph shows diffuse, fine nodular changes, seen in the lower lobes.

HRCT of a patient with pulmonary KS at the level of the main bronchi shows ground-glass attenuation areas in the posterior regions of both lungs, which correspond to pulmonary hemorrhage. Peribronchovascular thickening is observed in the right lung, as well as bilateral pleural effusion.

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