[AIDS-related pulmonary Kaposi's sarcoma: role of high-resolution computerized tomography]. / Sarcoma di Kaposi polmonare nell'AIDS: ruolo della Tomografia Computerizzata con alta risoluzione.

INTRODUCTION: HIV-related Kaposi sarcoma (KS) is characterized by lesion multifocality, stronger progression and recurrent involvement of some internal organs. Pulmonary lesions are found in 18-47% of cases and not necessarily associated with skin involvement. Lung infections are potentially life-threatening and their early and prompt demonstration is a crucial step for both treatment planning and the prognosis of this severe disease. As a rapid recognition of a pulmonary condition leads to a complete or partial regression in at least 50% of cases, we investigated the role and the diagnostic yield of HRCT in depicting HIV-related KS. MATERIAL AND METHODS: The findings of thirty-nine patients with HIV-related pulmonary KS were retrospectively reviewed. We excluded the patients with associated diseases and incomplete radiologic findings and included 12 patients who had a chest radiograph and a HRCT scanning at least. HRCT showed parenchymal and subpleural micronodules (< 10 mm) and macronodules (> 10 mm), with the halo sign in some cases; perivascular and peribronchial infiltrates, linear or irregular opacities, pleural effusions and enlarged lymph nodes were also seen. Chemotherapy response was also evaluated. RESULTS: All 12 patients had advanced AIDS. The chest films showed abnormal patterns, such as peribronchial and perivascular infiltrates which were most often in midlower pulmonary lobes (88.9%) and often symmetric. Nodules were depicted in 50% of cases and were often associated with peribronchial and perivascular infiltrates; they were always bilateral and characterized by the presence of macronodules in most cases. Eleven of 12 HRCT examinations were considered sufficiently accurate for evaluation, while a pleural effusion prevented lung assessment in one case. Peribronchial and perivascular infiltrates were the most frequent abnormal findings (83.3%), with bilateral involvement in 80% and mostly in the midlower lobes (90%). Parenchymal and subpleural nodules were depicted in 58.3% of cases and always had irregular borders; the halo sign was seen around the nodules in 2 cases and macronodules were found in 2 cases. Pleural effusions were seen in 3 cases and enlarged lymph nodes in 4. Lung KS diagnosis was always confirmed at pathology. The response to chemotherapy (ABV protocol) was evaluated in 5 patients: transient and definitive regressions were observed in 1 and 2 cases, respectively, and disease progression was seen in 2 cases. CONCLUSIONS: HRCT allows the accurate assessment of pulmonary KS in its different stages detailing the disease and its spread, which makes biopsy easier. It also permits to avoid more invasive diagnostic procedures and it is useful in the follow-up after chemotherapy.

[Invasive aspergillosis in AIDS: findings with high-resolution computerized tomography]. / Aspergillosi invasiva nell'AIDS: reperti con Tomografia Computerizzata con alta risoluzione.

PURPOSE: To review the early CT findings of invasive aspergillosis in AIDS patients who are at high risk for developing this infection. Early recognition of invasive fungal disease is imperative in these patients, and longer survival can be achieved with early CT detection and prompt institution of high-dose antifungal therapy. MATERIAL AND METHODS: February, 1992 to December, 1994, sixteen cases of invasive pulmonary aspergillosis in AIDS patients were retrospectively reviewed. All patients underwent a chest radiograph and high-resolution Computed Tomography (HRCT) and the results were confirmed by pathology. RESULTS: 11/16 cases (68.8%) showed angioinvasive aspergillosis, characterized by nodules surrounded by the halo sign and cavitations; the remaining 5 patients (31.2%) showed invasive aspergillosis of the airways with centrilobular nodules and/or peribronchial consolidations. Five cases of extrapulmonary fungal dissemination were also observed. CONCLUSIONS: HRCT is a sensitive noninvasive method for evaluating early angioinvasive aspergillosis because the halo sign is characteristic enough to allow an early presumptive diagnosis. Invasive aspergillosis of the airways presents no characteristic radiologic pattern. However, the association of the clinical and radiologic pattern allows prompt institution of high-dose antifungal therapy.

[Pneumocystis carinii lung infections in AIDS patients: a study with high-resolution computed tomography (HRCT)]. / Infezioni polmonari da Pneumocystis carinii nei pazienti affetti da AIDS: studio con Tomografia Computerizzata con alta risoluzione (HRCT).

In 1993, a hundred and fifty AIDS patients were submitted to high-resolution CT (HRCT). In 102 patients, bronchoalveolar lavage and/or transbronchial biopsy findings suggested the diagnosis of Pneumocystis carinii pneumonia--a pure Pneumocystis carinii infection in 75 patients and associated with other pathogenic agents in 27. We report the most common HRCT patterns, such as ground-glass opacities, cysts, interstitial changes and nodules. Ground-glass opacities were demonstrated in 57.8% of cases, cysts in 44.1%, interstitial involvement in 52.9% and nodules in 28.4%. HRCT permitted lung disease to be demonstrated in 55% of our patients, suffering from impaired breathing, with negative chest films. Respiratory function tests and gallium scintigraphy show their low specificity in the diagnosis of Pneumocystis carinii infection because, although depicting diffuse interstitial involvement, they fail to detect the pathogenic agent. As for hemogasanalysis, in the presence of hypoxia, this technique can suggest the diagnosis of Pneumocystis carinii infection, while the pathogenic agent can be isolated with bronchoalveolar lavage, which demonstrates the simultaneous decrease in CD4 and increase in CD8 lymphocytes, respectively. To conclude, HRCT does detect the basic changes occurring in Pneumocystis carinii pneumonia, thus contributing to the diagnosis of this condition.

[High-resolution computed tomography (HRCT) versus bronchoscopy in predicting the need for bronchial embolization in hemoptysis]. / Tomografia Computerizzata ad alta risoluzione (HRCT) versus broncoscopia in previsione di embolizzazione bronchiale nelle emottisi.

September, 1992, through May, 1994, thirty patients with hemoptysis were examined with CT, HRCT and bronchoscopy. Our study was aimed at comparing CT and HRCT with fiberoptic bronchoscopy in the identification and assessment of hemoptysis causes and of lesion shape and extent. These data are of basic importance for the interventional radiologist when an intravascular treatment is scheduled. The causes of hemoptysis included cystic fibrosis in 14 patients, bronchiectasis and bronchiolectasis in 11, tuberculosis in 3 and aspergillosis in one. In only one patient the etiology of hemoptysis remained undetected. Among the most common patterns, the "ground-glass" one was the main finding (50%), while bronchiectasis and bronchiolectasis were demonstrated in 40% of the patients. In the extent 10% of cases the cause of hemoptysis was identified with small lesions as a result of previous tubercular infections. Among the causes of hemoptysis, our study included only inflammatory, and not neoplastic, diseases. In 97% of patients, CT and HRCT allowed the diagnosis of lesion type, extent and site, while bronchoscopy did the same in only 35% of patients, because of its lack of accuracy in identifying and characterizing peripheral lesions. Our results suggest that CT and HRCT should be performed after bronchoscopy and before bronchial embolization. Confirming literature data, our study proves CT and HRCT to play a basic role in the diagnosis of the inflammatory conditions causing hemoptysis.