AIDS

AIDS

R. Brooke Jeffrey, MD

Key Facts

Terminology

Abdominal opportunistic infections and neoplasms resulting from AIDS-related immunodeficiency

Imaging

Best diagnostic clue
- Multiple focal hepatic or splenic lesions in patient with known AIDS
- Necrotic mesenteric nodes in patient with AIDS
Best imaging tool
- CECT
Affects all intraabdominal organs and gastrointestinal tract
Retroperitoneal nodes and masses

Top Differential Diagnoses

Non-AIDS lymphoma
Biliary hamartoma
Gastrointestinal stromal tumor
Crohn disease
Castleman disease

Clinical Issues

Now pandemic, with over 30,000,000 people affected worldwide
Multiple opportunistic infections and AIDS-related tumors develop unless retroviral drugs suppress HIV

Diagnostic Checklist

Consider
- AIDS-related lymphoma in patient with bulky hepatic mass
Image interpretation pearls
- MAI and tuberculosis cause necrotic nodes
- Kaposi sarcoma causes hypervascular retroperitoneal nodes and periportal liver lesions

(Left) Axial CECT in a 36-year-old man with AIDS shows widespread thoracoabdominal lymphadenopathy

, with many of the nodes having a hyperdense (hypervascular) appearance that is characteristic of involvement by Kaposi sarcoma. (Right) Longitudinal ultrasound in an AIDS patient with liver dysfunction shows innumerable small echogenic foci

within the liver. These are healed, calcified granulomas that have resulted from hepatic infection with Mycobacterium avium complex.

(Left) Axial CECT in a 45-year-old patient with a history of substance abuse, presenting with a 3-week history of fever, diarrhea, and profound weight loss shows multiple sites of low-attenuation lymphadenopathy involving the retroperitoneal

and mesenteric nodes

. (Right) Axial CECT in the same patient shows the retroperitoneal and mesenteric nodes and a prominent retrocaval node

displacing the IVC anteriorly. Biopsy confirmed Mycobacterium avium intracellulare.

TERMINOLOGY

Abbreviations

Acquired immune deficiency syndrome (AIDS)

Synonyms

Human immunodeficiency virus (HIV)

Definitions

Abdominal opportunistic infections and neoplasms resulting from AIDS-related immunodeficiency

IMAGING

General Features

Best diagnostic clue
- Multiple focal hepatic or splenic lesions in patient with known AIDS
- Necrotic mesenteric nodes in patient with AIDS
  - Mycobacterium avium intracellulare (MAI)
Location
- Affects all intraabdominal organs and gastrointestinal (GI) tract
- Retroperitoneal nodes and masses
Size
- Lesions vary from microabscesses (5 mm) to large, bulky abdominal masses due to lymphoma or Kaposi sarcoma
Morphology
- Bulky hepatic or GI tract masses from AIDS-related lymphoma