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Huson MAM, Kumwenda T, Gumulira J, Rambiki E, Wallrauch C, Heller T. Ultrasound findings in Kaposi sarcoma patients: overlapping sonographic features with disseminated tuberculosis. Ultrasound J 2023; 15:27. [PMID: 37258984 DOI: 10.1186/s13089-023-00323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Focused Assessment with Sonography for HIV-associated TB (FASH) is a diagnostic tool for extra-pulmonary tuberculosis (TB) in symptomatic patients with advanced HIV. As Kaposi's sarcoma (KS) is also prevalent in this patient population, changes due to KS may mimic TB findings and clinical interpretation of target FASH findings can be challenging. We aimed to describe sonographic findings in patients with KS. METHODS We performed a prospective observational study at Lighthouse clinic at Kamuzu Central Hospital, Lilongwe, Malawi, in consecutive patients with newly diagnosed KS, without known diagnosis of TB, referred for paclitaxel treatment. All patients underwent FASH and abdominal ultrasound to assess for effusions and changes in liver and spleen, as well as systematic sonographic assessment for lymphadenopathy. RESULTS We included 30 patients. We found inguinal lymph nodes using ultrasound in 20 patients; in 3 (10%) additionally abdominal lymph nodes were found. Pathological effusions were seen in eight patients (27%): pericardial effusion in one (3%), pleural effusion in six (20%) and ascites in four (13%) patients. We found focal spleen lesions in three (10%) patients. Most of these lesions were echogenic, but in one patient, we saw hypoechoic lesions with an echogenic center. In three (10%) patients an unusual "sponge-like pattern" of the splenic vasculature was found. Six (20%) patients had echogenic focal lesions in the liver resembling hemangiomas, individual lesions showing a hypoechoic center. In two patients echogenic portal fields were seen. CONCLUSIONS The majority of patients with newly diagnosed KS demonstrate sonographic features of disease, predominantly lymphadenopathy. Effusions were observed in a significant minority, as well as focal lesions in liver or spleen, which commonly resemble hemangiomas, but hypoechoic lesions were also observed and can easily be mistaken for extra-pulmonary TB. A 'sponge-like pattern' of the spleen should not be confused with micro-abscesses. In conclusion, this case series illustrates the diverse nature of ultrasound features in patients with KS, which can be difficult to distinguish from other opportunistic diseases, including TB.
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Affiliation(s)
| | - Tapiwa Kumwenda
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, Mzimba Street, 106, Lilongwe, Malawi
| | - Joe Gumulira
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, Mzimba Street, 106, Lilongwe, Malawi
| | - Ethel Rambiki
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, Mzimba Street, 106, Lilongwe, Malawi
| | - Claudia Wallrauch
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, Mzimba Street, 106, Lilongwe, Malawi
| | - Tom Heller
- Lighthouse Clinic, Kamuzu Central Hospital, Area 33, Mzimba Street, 106, Lilongwe, Malawi.
- International Training and Education Center for Health, University of Washington, Seattle, WA, USA.
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Okamoto T. Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer. World J Gastroenterol 2022; 28:985-1008. [PMID: 35431494 PMCID: PMC8968522 DOI: 10.3748/wjg.v28.i10.985] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/03/2021] [Accepted: 02/16/2022] [Indexed: 02/06/2023] Open
Abstract
Malignant biliary obstruction generally results from primary malignancies of the pancreatic head, bile duct, gallbladder, liver, and ampulla of Vater. Metastatic lesions from other primaries to these organs or nearby lymph nodes are rarer causes of biliary obstruction. The most common primaries include renal cancer, lung cancer, gastric cancer, colorectal cancer, breast cancer, lymphoma, and melanoma. They may be difficult to differentiate from primary hepato-pancreato-biliary cancer based on imaging studies, or even on biopsy. There is also no consensus on the optimal method of treatment, including the feasibility and effectiveness of endoscopic intervention or surgery. A thorough review of the literature on pancreato-biliary metastases and malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer is presented. The diagnostic modality and clinical characteristics may differ significantly depending on the type of primary cancer. Different primaries also cause malignant biliary obstruction in different ways, including direct invasion, pancreatic or biliary metastasis, hilar lymph node metastasis, liver metastasis, and peritoneal carcinomatosis. Metastasectomy may hold promise for some types of pancreato-biliary metastases. This review aims to elucidate the current knowledge in this area, which has received sparse attention in the past. The aging population, advances in diagnostic imaging, and improved treatment options may lead to an increase in these rare occurrences going forward.
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Affiliation(s)
- Takeshi Okamoto
- Department of Gastroenterology, St. Luke’s International Hospital, Chuo-ku 104-8560, Tokyo, Japan
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Abstract
Kaposi sarcoma (KS) is a form of cancer that primarily appears on the skin but can potentially involve internal organs. There are several types of KS. The purpose of this article is to discuss the manifestations of KS and their appearance on imaging, the differential diagnoses associated with these findings, and molecular markers associated with KS that can aid appropriate diagnosis and therapy.
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Beyond pyogenic liver abscess: a comprehensive review of liver infections in emergency settings. Emerg Radiol 2020; 27:307-320. [PMID: 32052222 DOI: 10.1007/s10140-020-01757-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 02/02/2020] [Indexed: 12/14/2022]
Abstract
Hepatobiliary infections are commonly encountered in emergency settings ranging from common pathology such as pyogenic abscess to relatively uncommon and rare etiologies. Since extensive literature is already available on imaging of more common bacterial infections, for the sake of focused discussion, this review will discuss radiological appearance of less commonly encountered hepatic infections of fungal, parasitic, viral, and tubercular etiologies. Epidemiological and clinical information remain extremely important for obtaining more accurate presumptive diagnosis. In the era of diverse population migration, a modern-era radiologist must be well versed about the imaging spectrum of liver infections.
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Atsukwei D, Eze ED, Chom ND, Igoh EO, Owoeye SC, Angbalaga A, Akut DA. Correlation between Abdominal Ultrasonographic Findings and CD4 Cell Count in Adult Patients with HIV/AIDS in Jos, Nigeria. ACTA ACUST UNITED AC 2017. [DOI: 10.4236/ami.2017.73003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
Diffusely increased uptake is more commonly observed than focal uptake in the spleen on a whole-body [F] fluorodeoxyglucose-positron emission tomography/computed tomography. The significance of diffusely increased splenic uptake varies in different clinical settings. On a pre-therapeutic scan for lymphoma, splenic uptake, greater than hepatic uptake, is a relative reliable indication of lymphomatous involvement of the spleen, unless the patient has a history of recent cytokine administration. In HIV infection, increased splenic uptake is usually noted in the early stage of the disease, which could reflect massive stimulation of B-cells in the spleen by nonreplicating antigenic material. Diffusely increased splenic uptake may also be present in sarcoidosis, malaria, and many inflammatory or hematopoietic diseases. Therapeutic-related reactive splenic uptake concurrent with bone marrow uptake is often secondary to administration of granulocyte colony-stimulating factor for myelosuppression or high-dose interferon-alpha-2b adjuvant therapy for melanoma.
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Mortelé KJ, Peters HE. Multimodality Imaging of Common and Uncommon Cystic Focal Liver Lesions. Semin Ultrasound CT MR 2009; 30:368-86. [DOI: 10.1053/j.sult.2009.07.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Restrepo CS, Martínez S, Lemos JA, Carrillo JA, Lemos DF, Ojeda P, Koshy P. Imaging Manifestations of Kaposi Sarcoma. Radiographics 2006; 26:1169-85. [PMID: 16844940 DOI: 10.1148/rg.264055129] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Kaposi sarcoma (KS) is a low-grade vascular tumor that typically manifests as one of four variants: classic KS, endemic (African) KS, iatrogenic (organ transplant-related) KS, or acquired immunodeficiency syndrome (AIDS)-related KS. Several clinical and epidemiologic differences have been noted among these variants. Classic KS and endemic KS rarely require radiologic evaluation due to their usually chronic course and stability of skin compromise. However, iatrogenic KS and AIDS-related KS, the most common forms of the disease, are frequently disseminated or symptomatic and may thus require imaging studies for both diagnosis and staging. KS is the most common tumor among AIDS patients, affecting a high percentage of these individuals, and is considered to be an AIDS-defining illness. Multiple organs can be involved by AIDS-related KS. KS has been linked with human herpes virus type 8 infection and other cofactors. Although pulmonary, gastrointestinal, and skin involvement by KS has previously been described, this tumor can affect multiple organs, generating a wide spectrum of imaging findings and pathologic correlates. It is important for the radiologist to be familiar with this spectrum of imaging manifestations and corresponding pathologic findings.
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Affiliation(s)
- Carlos S Restrepo
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
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Abstract
Recent technologic advances have significantly enhanced the role of imaging in the detection, characterization, and management of infectious diseases involving the liver. In addition, imaging-guided percutaneous drainage has greatly improved the clinical treatment of patients with focal liver abscess. Infectious liver diseases can be accurately evaluated with ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging. Characteristic changes in US echogenicity, CT attenuation, or MR imaging signal intensity and typical enhancement patterns can contribute to the diagnosis of specific infectious diseases, including abscesses, parasitic diseases, fungal diseases, granulomatous diseases, viral hepatitis, and other less common infections. CT is particularly helpful in revealing the presence of calcifications and gas and in detailing the enhancement pattern. The multiplanar capability of MR imaging and its sensitivity to small differences in tissue composition increase its specificity for certain hepatic infections, including hydatid cyst and candidiasis. Radiologic findings may be sufficient to obviate aspiration or histologic examination, although in most instances they are less specific. Nevertheless, imaging findings taken together with appropriate clinical information may provide the most likely diagnosis, even if biopsy is sometimes required for confirmation.
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MESH Headings
- Angiomatosis, Bacillary/diagnostic imaging
- Angiomatosis, Bacillary/pathology
- Animals
- Candidiasis/diagnostic imaging
- Candidiasis/pathology
- Cat-Scratch Disease/diagnostic imaging
- Cat-Scratch Disease/pathology
- Echinococcosis, Hepatic/diagnostic imaging
- Echinococcosis, Hepatic/pathology
- Granuloma/diagnostic imaging
- Granuloma/pathology
- HIV Infections/diagnostic imaging
- HIV Infections/pathology
- Hepatitis/diagnostic imaging
- Hepatitis/pathology
- Hepatitis, Viral, Human/diagnostic imaging
- Hepatitis, Viral, Human/pathology
- Humans
- Liver Abscess/diagnostic imaging
- Liver Abscess/pathology
- Liver Abscess, Amebic/diagnostic imaging
- Liver Abscess, Amebic/pathology
- Magnetic Resonance Imaging
- Schistosomiasis/diagnostic imaging
- Schistosomiasis/pathology
- Tomography, X-Ray Computed
- Tuberculoma/diagnostic imaging
- Tuberculoma/pathology
- Tuberculosis, Hepatic/diagnostic imaging
- Tuberculosis, Hepatic/pathology
- Ultrasonography
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Affiliation(s)
- Koenraad J Mortelé
- Division of Abdominal Imaging and Intervention, Department of Radiology, Brigham & Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115, USA.
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Megremis S, Segkos N, Daskalaki M, Tzortzakakis E, Paspatis G, Zois E, Sfakianaki E. Gallbladder cryptosporidiosis in a patient with acquired immunodeficiency syndrome: sonographic evaluation of the disease's course. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2004; 23:137-140. [PMID: 14756363 DOI: 10.7863/jum.2004.23.1.137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Stylianos Megremis
- First Department of Radiology, Venizelio General Hospital, Crete, Greece.
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Reiter GS. Clinical correlates of human immunodeficiency virus (HIV)-related immunosuppression. Semin Ultrasound CT MR 1998; 19:128-32. [PMID: 9567318 DOI: 10.1016/s0887-2171(98)90055-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Opportunistic infections and cancers, collectively referred to as opportunistic diseases (OD), occur with increasing frequency as HIV-related immunosuppression advances. Knowledge of an individual's degree of immunosuppression, as measured by his or her CD4 cell count, will assist a clinician in constructing a differential diagnosis to account for a given clinical presentation. Likewise, the correlation of an individual's immunosuppression with their symptoms will enable a radiologist to assist a clinician in determining which radiological studies are most likely to lead to a diagnosis.
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Affiliation(s)
- G S Reiter
- University of Massachusetts Medical Center Worcester, MA, USA
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