Presentation
Worsening dyspnea in an HIV+ patient.
Patient Data
Bilateral predominantly perihilar opacities are present as well as multiple nodules.
Bilateral "flame-shaped" peribronchovascular opacities and nodules are present, as well as increased septal lines and mildly enlarged mediastinal and bilateral axillary lymph nodes.
The lower power image shows spindle cell proliferation around vessels, characteristic of Kaposi sarcoma growth along bronchovascular bundles. The higher power image shows a vessel in the center surrounded by spindle cells.
Case Discussion
The differential diagnosis for nodular peribronchovascular opacities with nodular septal thickening includes sarcoidosis, lymphoma, lymphangitic spread of carcinoma, and Kaposi sarcoma. The "flame-shaped" pattern with spread along bronchovascular bundles is characteristic of Kaposi sarcoma and was the leading differential consideration in this young HIV+ patient and was pathologically confirmed.