Imaging Features of Pulmonary Kaposi Sarcoma–Associated Immune Reconstitution Syndrome
Myrna C. B. Godoy1,2,
Hannah Rouse1,
Jacqueline A. Brown1,
Peter Phillips3,
David M. Forrest4 and
Nestor L. Müller5
1 Department of Radiology, St. Paul's Hospital, University of British Columbia,
Vancouver, BC, Canada.
2 Department of Radiology, New York University School of Medicine, 650 First
Ave., 600-A, New York, NY 10016.
3 Division of Infectious Diseases, St. Paul's Hospital, University of British
Columbia, Vancouver, BC, Canada.
4 Division of Infectious Diseases, Nanaimo Regional Hospital, Nanaimo, BC,
Canada.
5 Department of Radiology, Vancouver General Hospital, University of British
Columbia, Vancouver, BC, Canada.
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Fig. 1A —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. Chest radiograph
before onset of immune reconstitution syndrome shows mild reticular opacities
in predominantly perihilar distribution.
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Fig. 1B —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. Chest radiograph
obtained during initial symptoms of Kaposi sarcoma–associated immune
reconstitution syndrome shows increase in reticular opacities and development
of areas of consolidation associated with Kerley B lines and small pleural
effusions.
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Fig. 1C —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. Follow-up chest
radiograph obtained 17 days after B shows rapid increase in amount of
consolidation, reticular opacities, and pleural effusion.
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Fig. 2A —44-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. Chest radiograph obtained during onset of immune
reconstitution syndrome shows reticulonodular opacities in predominantly
perihilar distribution.
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Fig. 2B —44-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. CT scan (5-mm slice thickness reconstruction) shows
bilateral irregular nodules, lobular consolidation in left upper lobe,
interlobular septal thickening, and fissural nodularity.
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Fig. 2C —44-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. Follow-up chest radiograph obtained 16 days after
A shows increase in nodular opacities and development of areas of
consolidation and bilateral pleural effusions.
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Fig. 2D —44-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. Follow-up CT scan (5-mm slice thickness
reconstruction) obtained 14 days after B shows increase in size and
number of nodules, some with halo sign, increase in extent of consolidation
and interlobular septal thickening, and development of bilateral pleural
effusions.
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Fig. 3A —31-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. CT scan (1.25-mm slice thickness reconstruction) of
right upper lobe shows ground-glass opacities, irregular ill-defined nodules
with ground-glass halo (halo sign), and pleural effusion.
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Fig. 3B —31-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. CT scan (1.25-mm slice thickness reconstruction) of
right lower lobe shows irregular nodules, interlobular septal thickening, and
pleural effusion.
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Fig. 3C —31-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. CT scans (5-mm slice thickness reconstruction) of
right upper lobe (C) and right lower lobe (D) obtained 21 days
after A and B show extensive progression of disease
characterized by increase in number and size of nodules, confluence of
nodules, development of consolidation, and increase in pleural fluid.
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Fig. 3D —31-year-old man with Kaposi sarcoma–associated immune
reconstitution syndrome. CT scans (5-mm slice thickness reconstruction) of
right upper lobe (C) and right lower lobe (D) obtained 21 days
after A and B show extensive progression of disease
characterized by increase in number and size of nodules, confluence of
nodules, development of consolidation, and increase in pleural fluid.
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Fig. 4A —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. CT scans (5-mm slice
thickness reconstruction) at level of carina (A) and inferior pulmonary
veins (B) show central peribronchovascular thickening and bilateral
pleural effusion.
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Fig. 4B —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. CT scans (5-mm slice
thickness reconstruction) at level of carina (A) and inferior pulmonary
veins (B) show central peribronchovascular thickening and bilateral
pleural effusion.
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Fig. 4C —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. CT scans (5-mm slice
thickness reconstruction) at level of carina (C) and inferior pulmonary
veins (D) obtained 14 days after A and B show increase in
peribronchovascular thickening and pleural effusion and development of
bilateral perihilar consolidation.
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Fig. 4D —59-year-old man with autopsy-confirmed Kaposi
sarcoma–associated immune reconstitution syndrome. CT scans (5-mm slice
thickness reconstruction) at level of carina (C) and inferior pulmonary
veins (D) obtained 14 days after A and B show increase in
peribronchovascular thickening and pleural effusion and development of
bilateral perihilar consolidation.
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Copyright © 2007 by the American Roentgen Ray Society.
