non infectious lung diseases
TRANSCRIPT
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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