Endobronchial manifestations of HIV infection are rare.

Endobronchial manifestations of HIV infection are rare. The endobronchial appearance and clinical presentation of these lesions may remind of the correct diagnosis. Establishing an appropriate differential diagnosis at the time of visualization of the endobronchial lesion is important because more [i]or[/i] less lesions require specific biopsy techniques or special stains. The bronchoscopist must consider the risks v benefits of biopsy when bring into the presence ofed with an endobronchial lesion. With the notable exception of pseudomembranous necrotizing tracheobronchial aspergillosis, there are no specific endobronchial lesions associated with HIV infection which increase the risk of complications when they are biopsied. Although EK is a vascular lesion and an early case report prompted that endobronchial biopsy might spring in excessive bleeding, this complication was not observ in pair subsequent series. Fortunately, a presumptive diagnosis of EK can usually be made without biopsy by means of the characteristic appearance of the lesion. EK is the greatest in quantity common endobronchial lesion associated with HIV infection; however, its incidence will probably decline as the incidence of K declines. Many of the other endobronchial lesions described herein have been reported freshly We suspect these and other lesions will be plant more frequently, as the epidemic of HIV continues to evolve

The discovery of an endobronchial lesion during bronchoscopy in a patient infected with the human immunodeficiency virus (HIV) is a rare and frequently surprising finding. Knowledge of the clinical presentation and endobronchial appearance of these lesions is important because several require specific biopsy techniques. In addition, the appearance of some of these lesions has prognostic significance.

The sense of this review is to describe the clinical presentation, endobronchial appearance, and diagnostic techniques of the various endobronchial lesions known to be associated with HIV infection. These lesions are listed in Table 1

KAPOSI'S SARCOMA

Kaposi's sarcoma (KS) fall outs frequently in HIV-infected individuals who are homosexual or bisexual, and its carriage establishes the diagnosis of the acquired immunodeficiency syndrome (AIDS). The proportion of AIDS cases with K appears to be declining, possibly because the proportion of AIDS cases with homosexuality as a risk factor is declining.

Thoracic K usually involves the lung parenchyma, pleura, intrathoracic lymph nodes, and the airways.[1] K of the thorax has been lay the foundation of in up to 49 percent of patients with cutaneous KS[2-4] and it rarely be founds without KS involvement of another site.[5-7] Fouret and coworkers[7] raise the mean duration of cutaneous disease before the diagnosis of bronchopulmonary K was 10 months[7]

Naidich and coworkers[8] reviewed 114 patients with bronchopulmonary K and establish the incidence of endobronchial Kasposi's sarcoma (EKS) to be 28 percent Presenting complaints of patients with EK include dyspnea and cough[6-9] Life-threatening upper airway obstruction may occur[10-11] febrile affection is common, even in the absence of a concomitant opportunistic infection.[6,9] Auscultation of the chest may reveal wheezing or stridor.[12] Almost all patients with EK have lesions in the oropharynx.[2,5,9]

Chest radiographs with EK are nonspecific, and the bronchoscopic bulk of EKS does not correlate with the grade of radiographic abnormality.[5] The chest radiograph may indicate perihilar infiltrates, diffuse nodular infiltrates, diffuse interstitial infiltrates, pleural effusions, or it may be normal.[5,9,12] Approximately half the patients with EK have normal pulmonary function, while half demonstrate an obstructive ventilatory defect[512]

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The endobronchial appearance of K is almost always erythematous in contrast to the violaceous appearance of the skin and oropharyngeal lesions (Fig 1)[913] The lesions may be macular or papular. Lesions look after to be discrete in the trachea, while they may appear as diffuse commingling hyperemic areas (Fig 2) in distal airways.[9] Careful examination of the bronchial tree is essential, since small focal areas of erythema may be overlooked[7] These EK lesions are usually numerous and widespread from top to toe the tracheobronchial tree.[5,13] Pozniak and coworkers reported 75 percent of their patients with EK had more than 15 visible lesions.[13]

Knowledge of the bronchoscopic appearance of EK is essential, since a presumptive diagnosis can be made based forward the characteristic appearance of the lesions.[1] Biopsy probably has clinical utility in K patients with uncharacteristic endobronchial lesions who have an abnormal chest radiograph or pulmonary symptoms. Biopsy may be necessary in the unusual patient with EK who has no other known organ involvement with K Although an early report refer toed that endobronchial biopsy of EK might be the effect in excessive bleeding,[14] this complication is rare.[9,15]

suitable endobronchial biopsy technique of EK may be important in increasing the diagnostic yield. Ideal locations for biopsy of EK lesions are at carinae subdividing segmental orifices.[9] Although like EKS lesions are usually not as discrete as lesions in the proximal airways, the former sites are preferr because the angel of the forceps at the twinkling of an eye of biopsy is less acute than in the trachea or mainstem bronchus. In addition, a lesion at a small bronchial

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