Thread by @RyanChristieMD

Wetread Case 32

Hx: Cough, shortness of breath, fever 😡😡 (yep, I did 😁)

Any pertinent hx questions? 🤔

Feel free to answer with professionally appropriate gif responses only. No spoilers. wetread.org #WetreadCow #FOAMrad #FOAMed #radres #errad #chestrad

Would it help to know that the pt is immunosuppressed?

and NO it's NOT COVID-19! 😁

@RadioGyan @AdamSingerMD @xyzabrz @lala_layla_1

Answer: Kaposi’s Sarcoma

KS is a low-mid grade mesenchymal tumor that involves blood/lymphatic vessels of the skin, lymph nodes, lungs, GI tract, etc.

Not considered a true “sarcoma”

Believed related to human herpes virus type 8 (HHV8)

👏 to @DrAliya85 #chestrad #FOAMrad

Comes in 4 variants:

Classic - generally limited to lower limb w/ purple dermal plaques

Iatrogenic - related to immunosuppression during organ transplantation

AIDS-related - HIV+ patients with CD4 <200 (considered an AIDS defining illness)

Endemic - men in equatorial Africa

Imaging - XR:
- linear interstitial nodules vs fluffy ill-defined nodules often in a peri-hilar to mid/lower lung predominance. +pleural effusion +adenopathy

Different patient:

Imaging - CT:
- flame shaped nodular opacities in a symmetric/perihilar distribution with surrounding glass-glass appearance

- interstitial thickening w/ peribronchovascular nodular pattern

+ pleural effusion
+ adenopathy (can be of high attentuation)

Different patients:

Nuclear Medicine - can be helpful to differentiate from lymphoma

Th-201 - positive in both KS and lymphoma

Ga67 - usually negative in KS but positive in lymphoma/infection

Good luck to all and hoping everyone stays safe!