Intrathoracic Kaposi sarcoma in AIDS patients: radiographic-pathologic correlation

The chest radiographs and postmortem pathologic findings in 24 patients with acquired immunodeficiency syndrome (AIDS) and autopsy-proved intrathoracic Kaposi sarcoma were reviewed. Premortem radiographic visualization of pulmonary lesions of Kaposi sarcoma depended on the extent of involvement and the presence of concomitant disease. In three patients (13%) the radiographs showed nodular opacities that corresponded in size and configuration to nodules seen at autopsy. In 21 patients (87%) the lesions were not radiographically identifiable, in some cases because they were obscured by infection. The positive and negative predictive values of four radiographic findings for intrathoracic Kaposi sarcoma were evaluated, using a control group of 14 AIDS patients without intrathoracic Kaposi sarcoma at autopsy. Findings with a high positive predictive value were parenchymal nodular and reticular opacities (100%), pleural effusions (89%), and hilar and/or mediastinal lymphadenopathy (92%). None of these findings is specific, but the presence of any one in a patient with AIDS should increase the possibility of intrathoracic involvement by Kaposi sarcoma.