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Oncogenic Viruses in AIDS: Mechanisms of Disease and Intrathoracic Manifestations

¹ Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th St., Bronx, NY 10467.
² Department of Pathology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
³ Albert Einstein College of Medicine, Bronx, NY.

View larger version (131K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —43-year-old man with HIV presenting with cutaneous Kaposi sarcoma. Open lung biopsy revealed pulmonary Kaposi sarcoma. Posteroanterior (A) and lateral (B) chest radiographs show bilateral ill-defined nodules and areas of confluence with peribronchovascular and lower lobe predominance.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —43-year-old man with HIV presenting with cutaneous Kaposi sarcoma. Open lung biopsy revealed pulmonary Kaposi sarcoma. Posteroanterior (A) and lateral (B) chest radiographs show bilateral ill-defined nodules and areas of confluence with peribronchovascular and lower lobe predominance.

View larger version (113K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —43-year-old man with HIV presenting with cutaneous Kaposi sarcoma. Open lung biopsy revealed pulmonary Kaposi sarcoma. Axial chest CT scan shows findings typical of extensive Kaposi sarcoma, including ill-defined nodules, some flame-shaped, with areas of confluent consolidation and peribronchovascular predominance.

View larger version (137K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —33-year-old man with HIV infection, Kaposi sarcoma, and cough. Axial chest CT scan shows bilateral scattered ill-defined nodules, some in peribronchovascular distribution. Compared with Figure 1A, 1B, 1C, nodules are more scattered and less confluent.

View larger version (93K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —66-year-old man with Kaposi sarcoma. Posteroanterior radiograph of left chest shows thickening of interlobular septa and ill-defined peribronchovascular nodules.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —66-year-old man with Kaposi sarcoma. CT image at level of aortic arch shows thickened interlobular septa and ill-defined peribronchovascular nodules.

View larger version (180K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —38-year-old man with HIV infection, fever, and generalized lymphadenopathy. Pleural biopsy showed human herpesvirus 8 and Epstein-Barr virus in lymphoma cells, which is consistent with primary effusion lymphoma. CT digital radiograph shows extensive right pleural opacity, bilateral hilar and mediastinal lymphadenopathy, and splenomegaly (arrows).

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —38-year-old man with HIV infection, fever, and generalized lymphadenopathy. Pleural biopsy showed human herpesvirus 8 and Epstein-Barr virus in lymphoma cells, which is consistent with primary effusion lymphoma. Axial chest CT images show large pleural (arrows, C) and chest wall mass with associated pleural effusion. Note also pronounced right axillary lymphadenopathy.

View larger version (130K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —38-year-old man with HIV infection, fever, and generalized lymphadenopathy. Pleural biopsy showed human herpesvirus 8 and Epstein-Barr virus in lymphoma cells, which is consistent with primary effusion lymphoma. Axial chest CT images show large pleural (arrows, C) and chest wall mass with associated pleural effusion. Note also pronounced right axillary lymphadenopathy.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —41-year-old man with HIV infection and cough. Percutaneous biopsy revealed diffuse large B-cell lymphoma. Posteroanterior chest radiograph shows large mass in right upper and middle lobes.

View larger version (102K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —41-year-old man with HIV infection and cough. Percutaneous biopsy revealed diffuse large B-cell lymphoma. Axial chest CT scan shows large mass in right upper lobe and surrounding smaller nodules.

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —41-year-old man with HIV infection and cough. Percutaneous biopsy revealed diffuse large B-cell lymphoma. Endobronchial component to mass is seen at level of right upper lobe bronchus.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —51-year-old woman with lupus and HIV infection who presented with nonresolving pneumonia. Transbronchial biopsy showed B-cell non-Hodgkin's lymphoma. Posteroanterior chest radiograph shows bilateral ill-defined pulmonary nodules and masses that are more prominent on right side.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —51-year-old woman with lupus and HIV infection who presented with nonresolving pneumonia. Transbronchial biopsy showed B-cell non-Hodgkin's lymphoma. Axial chest CT scan shows bilateral ill-defined pulmonary nodules.

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —48-year-old woman with HIV infection who presented with generalized, palpable lymphadenopathy. Cervical lymph node biopsy showed diffuse large B-cell lymphoma. Posteroanterior chest radiograph shows bilateral hilar and mediastinal lymphadenopathy.

View larger version (64K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —48-year-old woman with HIV infection who presented with generalized, palpable lymphadenopathy. Cervical lymph node biopsy showed diffuse large B-cell lymphoma. Axial CT scans through mediastinum show multiple bilateral enlarged lymph nodes.

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7C —48-year-old woman with HIV infection who presented with generalized, palpable lymphadenopathy. Cervical lymph node biopsy showed diffuse large B-cell lymphoma. Axial CT scans through mediastinum show multiple bilateral enlarged lymph nodes.

View larger version (81K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8A —34-year-old man with long-standing HIV infection and 2-month history of cough. Transbronchial biopsy was negative. Bone marrow aspirate revealed Hodgkin's disease. Contrast-enhanced chest CT scans show extensive right paratracheal, right hilar, and subcarinal lymphadenopathy.

View larger version (100K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8B —34-year-old man with long-standing HIV infection and 2-month history of cough. Transbronchial biopsy was negative. Bone marrow aspirate revealed Hodgkin's disease. Contrast-enhanced chest CT scans show extensive right paratracheal, right hilar, and subcarinal lymphadenopathy.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8C —34-year-old man with long-standing HIV infection and 2-month history of cough. Transbronchial biopsy was negative. Bone marrow aspirate revealed Hodgkin's disease. CT scan at lung window setting shows patchy parenchymal opacities in right upper lobe.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 9 —40-year-old woman with cervical cancer. Anteroposterior chest radiograph shows multiple micronodular opacities with some confluence in right upper lobe. Differential diagnosis includes mycobacterial and fungal infection. Biopsy revealed micronodular metastatic cervical cancer.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10A —53-year-old woman with HIV infection and metastatic cervical cancer. Axial contrast-enhanced chest CT scan shows low-attenuation, necrotic subcarinal and bilateral hilar lymphadenopathy. Differential diagnosis includes other causes of necrotic lymphadenopathy such as tuberculosis.

View larger version (145K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 10B —53-year-old woman with HIV infection and metastatic cervical cancer. Axial contrast-enhanced CT scan of pelvis shows bulky primary mass arising from cervix and regional pelvic lymphadenopathy.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11A —45-year-old man with HIV infection and long history of smoking who presented with persistent cough and difficulty breathing. Transbronchial biopsy and subsequent left lower lobectomy revealed tracheobronchial and pulmonary papillomatosis and multiple foci of invasive squamous cell carcinoma in lung. Posteroanterior chest radiograph shows multiple subtle irregularities of trachea (black arrows) and mainstem bronchi. Left lower lobe nodule (white arrow) is present.

View larger version (120K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11B —45-year-old man with HIV infection and long history of smoking who presented with persistent cough and difficulty breathing. Transbronchial biopsy and subsequent left lower lobectomy revealed tracheobronchial and pulmonary papillomatosis and multiple foci of invasive squamous cell carcinoma in lung. Chest CT scans show multiple irregular tracheobronchial nodules. Parenchymal nodules are also present, some with cavitation.

View larger version (90K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11C —45-year-old man with HIV infection and long history of smoking who presented with persistent cough and difficulty breathing. Transbronchial biopsy and subsequent left lower lobectomy revealed tracheobronchial and pulmonary papillomatosis and multiple foci of invasive squamous cell carcinoma in lung. Chest CT scans show multiple irregular tracheobronchial nodules. Parenchymal nodules are also present, some with cavitation.

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 11D —45-year-old man with HIV infection and long history of smoking who presented with persistent cough and difficulty breathing. Transbronchial biopsy and subsequent left lower lobectomy revealed tracheobronchial and pulmonary papillomatosis and multiple foci of invasive squamous cell carcinoma in lung. Chest CT scans show multiple irregular tracheobronchial nodules. Parenchymal nodules are also present, some with cavitation.

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