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(Radiology. 2000;214:427-432.)
© RSNA, 2000

Thoracic Imaging

Multiple Pulmonary Nodules in AIDS: Usefulness of CT in Distinguishing among Potential Causes1

Keith J. Edinburgh, MD, MEd, Robert M. Jasmer, MD, Laurence Huang, MD, Gautham P. Reddy, MD, MPH, Myung H. Chung, MD, PhD, Annemarie Thompson, MD, Robert A. Halvorsen, Jr, MD and W. Richard Webb, MD

1 From the Depts of Radiology (K.J.E., G.P.R., M.H.C., R.A.H., W.R.W.) and Medicine (R.M.J., L.H., A.T.), Univ of California, San Francisco; Dept of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (K.J.E.); and Div of Pulmonary and Critical Care Medicine (R.M.J., L.H., A.T.) and Dept of Radiology (R.A.H.), San Francisco General Hospital, Calif. Received Nov 4, 1998; revision requested Jan 5, 1999; final revision received Apr 6; accepted May 12. L.H. supported in part by National Institutes of Health, Univ of California, San Francisco Center for AIDS Research grant P30 MH59037. Address reprint requests to K.J.E., Department of Radiology, North Memorial Medical Center, 3300 Oakdale Ave North, Minneapolis, MN 55422 (e-mail: kedinburgh@subrad.com).

PURPOSE: To determine whether the computed tomographic (CT) appearances of multiple pulmonary nodules in patients with acquired immunodeficiency syndrome (AIDS) can help differentiate the potential infectious and neoplastic causes.

MATERIALS AND METHODS: The thoracic CT scans obtained in 60 patients with AIDS and multiple pulmonary nodules were reviewed retrospectively by two thoracic radiologists who were blinded to clinical and pathologic data. The scans were evaluated for nodule size, distribution, and morphologic characteristics. CT findings were correlated with final diagnoses.

RESULTS: Thirty-six (84%) of 43 patients with opportunistic infection had a predominance of nodules smaller than 1 cm in diameter, whereas 14 (82%) of 17 patients with a neoplasm had a predominance of nodules larger than 1 cm (P < .001). Of the 43 patients with opportunistic infection, 28 (65%) had a centrilobular distribution of nodules; only one (6%) of 17 patients with a neoplasm had this distribution (P < .001). Seven (88%) of eight patients with a peribronchovascular distribution had Kaposi sarcoma (P < .001).

CONCLUSION: In patients with AIDS who have multiple pulmonary nodules at CT, nodule size and distribution are useful in the differentiation of potential causes. Nodules smaller than 1 cm, especially those with a centrilobular distribution, are typically infectious. Nodules larger than 1 cm are often neoplastic. A peribronchovascular distribution is suggestive of Kaposi sarcoma.

Index terms: Acquired immunodeficiency syndrome (AIDS), 60.2518 • Kaposi sarcoma, 60.346 • Lung, infection, 60.201, 60.202, 60.203, 60.217, 60.2518 • Lung neoplasms, 60.343, 60.346 • Lung, nodule, 60.281 • Lymphoma, AIDS-related, 60.343 • Mycobacteria, 60.203 • Thorax, CT, 60.12111, 60.12112, 60.12118 • Tuberculosis, pulmonary, 60.23




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