Multiple pulmonary nodules in AIDS: usefulness of CT in distinguishing among potential causes.
OBJECTIVE
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.


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).


CONCLUSIONS
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.
Edinburgh
K J
KJ
Dept of Radiology, Univ of California, San Francisco, USA. kedinburgh@subrad.com
Jasmer
R M
RM
Huang
L
L
Reddy
G P
GP
Chung
M H
MH
Thompson
A
A
Halvorsen
R A
RA
Webb
R A
RA
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging*; D001228:Aspergillosis / Q000000981:diagnostic imaging; D001424:Bacterial Infections / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging; D008175:Lung Neoplasms / Q000000981:diagnostic imaging; D016483:Lymphoma, AIDS-Related / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D009164:Mycobacterium Infections / Q000000981:diagnostic imaging; D012141:Respiratory Tract Infections / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D012514:Sarcoma, Kaposi / Q000000981:diagnostic imaging; D016037:Single-Blind Method; D014057:Tomography, X-Ray Computed