[Pulmonary and pleural localizations of Kaposi's sarcoma in AIDS]

Intrathoracic Kaposi's sarcoma (KS) in AIDS is remarkable for its frequency and severity. It is responsible for 10% of "pneumonias" and almost 50% of pleurisies observed in these patients. The time elapsed between the discovery of the lesion and the patient's death does not exceed a few months on average. The initial manifestations of pulmonary KS are usually discreet and consist of cough and/or dyspnoea in patients with KS of the skin and mucosae. Fever is lacking or moderate. The most suggestive radiological findings are dense, nodular, tumour-like opacities and bilateral linear and/or micronodular opacities around the bronchi and vessels. The diagnosis rests on bronchial fibroscopy which shows red, non friable lesions which, to a trained endoscopist, are very characteristic. When these lesions are absent, thoracotomy may be necessary for diagnostic purposes. Treatment essentially consists of chemotherapy; zidovudine therapy and prophylaxis of pneumocystosis are indicated if the circulating CD 4 cell count falls below 200/mm3. When its symptoms are predominant, pleural KS is typically progressive, with normal or slightly elevated temperature, associated parenchymal lesions that are clearly visible on CT scans and copious, bilateral, blood-stained serous or chylous pleural fluid. When these signs are absent throacoscopy or thoracotomy may be necessary. Future advances in this field will be due not only to improvements in chemotherapy but also to a better understanding of the physiopathology of intrathoracic Kaposi's sarcoma.