DOI: 10.1148/rg.261055058
Cardiovascular Complications of Human Immunodeficiency Virus Infection1
Carlos S. Restrepo, MD,
Lisa Diethelm, MD,
Julio A. Lemos, MD,
Enrique Velásquez, MD,
Ty A. Ovella, MD,
Santiago Martinez, MD,
Jorge Carrillo, MD and
Diego F. Lemos, MD
1 From the Departments of Radiology (C.S.R., L.D., J.A.L., T.A.O., S.M., D.F.L.) and Cardiology (E.V.), Louisiana State University Health Sciences Center, 1542 Tulane Ave, Room 212, New Orleans, LA 70112; and Universidad Nacional de Colombia, Hospital Santa Clara, Bogotá, Colombia (J.C.). Recipient of a Certificate of Merit award for an education exhibit at the 2004 RSNA Annual Meeting. Received March 21, 2005; revision requested May 2 and received June 3; accepted June 6. All authors have no financial relationships to disclose.
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Figure 1. Pericardial fluid in a 32-year-old woman with AIDS and a history of recurrent pneumonia. Unenhanced axial computed tomographic (CT) scan demonstrates a medium-sized pericardial effusion (arrows), as well as bilateral pleural fluid collections and slight dilatation of the heart.
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Figure 2. Pulmonary and pericardial tuberculosis in a 23-year-old man with HIV who presented with cardiac tamponade. Contrast material–enhanced CT scan of the chest depicts a large pericardial effusion and a loculated pleural fluid collection in the anterior right hemithorax. The pericardium appears as a thin line of slightly higher attenuation (arrow) between the two fluid collections.
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Figure 3. Myocardial tuberculosis in a 42-year-old man with AIDS. Gross autopsy specimen of the heart shows diffuse myocardial involvement, with caseous material within the walls of the left ventricle (curved arrows), thickened pericardium secondary to granulomatous infiltration (straight white arrows), and vegetation in an aortic valve cusp (black arrow).
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Figure 4a. Dilated cardiomyopathy in a 43-year-old man with AIDS. (a) Conventional radiograph from July 1998 shows a normal cardiac silhouette. (b) Conventional radiograph obtained in December 2003 shows a significantly enlarged cardiac silhouette and severe enlargement of the right heart chamber.
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Figure 4b. Dilated cardiomyopathy in a 43-year-old man with AIDS. (a) Conventional radiograph from July 1998 shows a normal cardiac silhouette. (b) Conventional radiograph obtained in December 2003 shows a significantly enlarged cardiac silhouette and severe enlargement of the right heart chamber.
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Figure 5a. Dilated cardiomyopathy in a 45-year-old woman with AIDS. (a) Apical four-chamber echocardiographic view shows marked enlargement of all four chambers, as well as spontaneous echo contrast ("smoke") in the left-sided chambers because of a very low ejection fraction and sluggish flow. (b) Apical four-chamber view obtained with color Doppler flow imaging shows an eccentric jet of severe regurgitation through the tricuspid valve. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.
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Figure 5b. Dilated cardiomyopathy in a 45-year-old woman with AIDS. (a) Apical four-chamber echocardiographic view shows marked enlargement of all four chambers, as well as spontaneous echo contrast ("smoke") in the left-sided chambers because of a very low ejection fraction and sluggish flow. (b) Apical four-chamber view obtained with color Doppler flow imaging shows an eccentric jet of severe regurgitation through the tricuspid valve. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle.
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Figure 6a. Dilated cardiomyopathy in a 38-year-old man with AIDS. (a) Digital radiograph shows an enlarged cardiac silhouette with left ventricular configuration and right-sided pleural effusion. (b) Apical four-chamber echocardiographic view obtained with color Doppler flow imaging shows severe tricuspid valve regurgitation and marked dilatation of all chambers. (c) Apical four-chamber gray-scale echocardiographic view better depicts enlargement of the chambers, as well as a markedly decreased ejection fraction (6%). (d) Contrast-enhanced axial CT scan demonstrates significantly enlarged right and left ventricles and a dilated inferior vena cava (arrowhead) and coronary sinus (arrow), as well as pericardial fluid, right-sided pleural effusion, and parenchymal consolidation in the lower lobe of the right lung. (e) CT scan at a lower level depicts the dilated inferior vena cava (arrowhead) and hepatic veins (arrows), as well as contrast material reflux via the right atrium.
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Figure 6b. Dilated cardiomyopathy in a 38-year-old man with AIDS. (a) Digital radiograph shows an enlarged cardiac silhouette with left ventricular configuration and right-sided pleural effusion. (b) Apical four-chamber echocardiographic view obtained with color Doppler flow imaging shows severe tricuspid valve regurgitation and marked dilatation of all chambers. (c) Apical four-chamber gray-scale echocardiographic view better depicts enlargement of the chambers, as well as a markedly decreased ejection fraction (6%). (d) Contrast-enhanced axial CT scan demonstrates significantly enlarged right and left ventricles and a dilated inferior vena cava (arrowhead) and coronary sinus (arrow), as well as pericardial fluid, right-sided pleural effusion, and parenchymal consolidation in the lower lobe of the right lung. (e) CT scan at a lower level depicts the dilated inferior vena cava (arrowhead) and hepatic veins (arrows), as well as contrast material reflux via the right atrium.
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Figure 6c. Dilated cardiomyopathy in a 38-year-old man with AIDS. (a) Digital radiograph shows an enlarged cardiac silhouette with left ventricular configuration and right-sided pleural effusion. (b) Apical four-chamber echocardiographic view obtained with color Doppler flow imaging shows severe tricuspid valve regurgitation and marked dilatation of all chambers. (c) Apical four-chamber gray-scale echocardiographic view better depicts enlargement of the chambers, as well as a markedly decreased ejection fraction (6%). (d) Contrast-enhanced axial CT scan demonstrates significantly enlarged right and left ventricles and a dilated inferior vena cava (arrowhead) and coronary sinus (arrow), as well as pericardial fluid, right-sided pleural effusion, and parenchymal consolidation in the lower lobe of the right lung. (e) CT scan at a lower level depicts the dilated inferior vena cava (arrowhead) and hepatic veins (arrows), as well as contrast material reflux via the right atrium.
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Figure 6d. Dilated cardiomyopathy in a 38-year-old man with AIDS. (a) Digital radiograph shows an enlarged cardiac silhouette with left ventricular configuration and right-sided pleural effusion. (b) Apical four-chamber echocardiographic view obtained with color Doppler flow imaging shows severe tricuspid valve regurgitation and marked dilatation of all chambers. (c) Apical four-chamber gray-scale echocardiographic view better depicts enlargement of the chambers, as well as a markedly decreased ejection fraction (6%). (d) Contrast-enhanced axial CT scan demonstrates significantly enlarged right and left ventricles and a dilated inferior vena cava (arrowhead) and coronary sinus (arrow), as well as pericardial fluid, right-sided pleural effusion, and parenchymal consolidation in the lower lobe of the right lung. (e) CT scan at a lower level depicts the dilated inferior vena cava (arrowhead) and hepatic veins (arrows), as well as contrast material reflux via the right atrium.
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Figure 6e. Dilated cardiomyopathy in a 38-year-old man with AIDS. (a) Digital radiograph shows an enlarged cardiac silhouette with left ventricular configuration and right-sided pleural effusion. (b) Apical four-chamber echocardiographic view obtained with color Doppler flow imaging shows severe tricuspid valve regurgitation and marked dilatation of all chambers. (c) Apical four-chamber gray-scale echocardiographic view better depicts enlargement of the chambers, as well as a markedly decreased ejection fraction (6%). (d) Contrast-enhanced axial CT scan demonstrates significantly enlarged right and left ventricles and a dilated inferior vena cava (arrowhead) and coronary sinus (arrow), as well as pericardial fluid, right-sided pleural effusion, and parenchymal consolidation in the lower lobe of the right lung. (e) CT scan at a lower level depicts the dilated inferior vena cava (arrowhead) and hepatic veins (arrows), as well as contrast material reflux via the right atrium.
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Figure 7a. Bacterial endocarditis with tricuspid valve involvement secondary to an atypical mycobacterial infection in a 56-year-old man with AIDS and a history of intravenous drug abuse. (a) Contrast-enhanced chest CT scan at the level of the ventricles shows right atrial enlargement (black arrow), consolidation in the lower lobe of the right lung (arrowhead), and a foreign body (a ballistic weapon fragment) in the right lung base (white arrow). (b) Right parasternal long-axis four-chamber echocardiographic view shows marked right atrial enlargement and a large area of echogenicity adjacent to the tricuspid valve (TV), a finding consistent with vegetation. LA = left atrium, RA = right atrium, RV = right ventricle. (c) Transesophageal echocardiographic view obtained with color flow Doppler imaging shows the large area of vegetation attached to the atrial side of the tricuspid valve, with associated valvular flailing and severe regurgitation. Multiple septic emboli also developed in the vessels supplying the lungs. The infective agent in this case was Mycobacterium fortuitum. RA = right atrium, RV = right ventricle.
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Figure 7b. Bacterial endocarditis with tricuspid valve involvement secondary to an atypical mycobacterial infection in a 56-year-old man with AIDS and a history of intravenous drug abuse. (a) Contrast-enhanced chest CT scan at the level of the ventricles shows right atrial enlargement (black arrow), consolidation in the lower lobe of the right lung (arrowhead), and a foreign body (a ballistic weapon fragment) in the right lung base (white arrow). (b) Right parasternal long-axis four-chamber echocardiographic view shows marked right atrial enlargement and a large area of echogenicity adjacent to the tricuspid valve (TV), a finding consistent with vegetation. LA = left atrium, RA = right atrium, RV = right ventricle. (c) Transesophageal echocardiographic view obtained with color flow Doppler imaging shows the large area of vegetation attached to the atrial side of the tricuspid valve, with associated valvular flailing and severe regurgitation. Multiple septic emboli also developed in the vessels supplying the lungs. The infective agent in this case was Mycobacterium fortuitum. RA = right atrium, RV = right ventricle.
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Figure 7c. Bacterial endocarditis with tricuspid valve involvement secondary to an atypical mycobacterial infection in a 56-year-old man with AIDS and a history of intravenous drug abuse. (a) Contrast-enhanced chest CT scan at the level of the ventricles shows right atrial enlargement (black arrow), consolidation in the lower lobe of the right lung (arrowhead), and a foreign body (a ballistic weapon fragment) in the right lung base (white arrow). (b) Right parasternal long-axis four-chamber echocardiographic view shows marked right atrial enlargement and a large area of echogenicity adjacent to the tricuspid valve (TV), a finding consistent with vegetation. LA = left atrium, RA = right atrium, RV = right ventricle. (c) Transesophageal echocardiographic view obtained with color flow Doppler imaging shows the large area of vegetation attached to the atrial side of the tricuspid valve, with associated valvular flailing and severe regurgitation. Multiple septic emboli also developed in the vessels supplying the lungs. The infective agent in this case was Mycobacterium fortuitum. RA = right atrium, RV = right ventricle.
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Figure 8. Severe mitral insufficiency in a 32-year-old woman with AIDS who presented with acute onset of shortness of breath. Conventional radiograph shows an enlarged cardiac silhouette, with left ventricular enlargement and asymmetric pulmonary edema that is more prominent in the right lung.
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Figure 9a. Bacterial endocarditis with multiple septic emboli in a 40-year-old man with AIDS and a history of intravenous drug abuse. Axial chest CT scans obtained with lung window settings demonstrate cavitary and noncavitary nodules (arrows in a) in both lungs, as well as an osteolytic lesion in the L1 vertebral body (curved arrow in b) and a left-sided paraspinal abscess (straight arrow in b).
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Figure 9b. Bacterial endocarditis with multiple septic emboli in a 40-year-old man with AIDS and a history of intravenous drug abuse. Axial chest CT scans obtained with lung window settings demonstrate cavitary and noncavitary nodules (arrows in a) in both lungs, as well as an osteolytic lesion in the L1 vertebral body (curved arrow in b) and a left-sided paraspinal abscess (straight arrow in b).
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Figure 10. Bacterial endocarditis secondary to atypical mycobacterial infection in the tricuspid valve in a 56-year-old man with AIDS and a history of intravenous drug abuse. Contrast-enhanced chest CT scan obtained with lung window settings at an infrahilar level shows parenchymal consolidation and areas of cavitation (arrow) secondary to septic emboli caused by M fortuitum.
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Figure 11a. Abdominal aortic aneurysm and bilateral common iliac artery aneurysms in a 60-year-old woman with AIDS who developed severe dyslipidemia while undergoing HAART. (a) Contrast-enhanced CT scan of the abdomen shows the dilated aorta with a mural thrombus (arrow). (b) Contrast-enhanced CT scan of the pelvis shows an aneurysm of the right common iliac artery (arrow), also with a mural thrombus, as well as a dissection of the left iliac artery (arrowhead). (c) Contrast-enhanced CT scan at a level caudal to b shows the aneurysms of the right and the left common iliac arteries (arrows), both with mural thrombi.
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Figure 11b. Abdominal aortic aneurysm and bilateral common iliac artery aneurysms in a 60-year-old woman with AIDS who developed severe dyslipidemia while undergoing HAART. (a) Contrast-enhanced CT scan of the abdomen shows the dilated aorta with a mural thrombus (arrow). (b) Contrast-enhanced CT scan of the pelvis shows an aneurysm of the right common iliac artery (arrow), also with a mural thrombus, as well as a dissection of the left iliac artery (arrowhead). (c) Contrast-enhanced CT scan at a level caudal to b shows the aneurysms of the right and the left common iliac arteries (arrows), both with mural thrombi.
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Figure 11c. Abdominal aortic aneurysm and bilateral common iliac artery aneurysms in a 60-year-old woman with AIDS who developed severe dyslipidemia while undergoing HAART. (a) Contrast-enhanced CT scan of the abdomen shows the dilated aorta with a mural thrombus (arrow). (b) Contrast-enhanced CT scan of the pelvis shows an aneurysm of the right common iliac artery (arrow), also with a mural thrombus, as well as a dissection of the left iliac artery (arrowhead). (c) Contrast-enhanced CT scan at a level caudal to b shows the aneurysms of the right and the left common iliac arteries (arrows), both with mural thrombi.
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Figure 12. Bilateral iliac vein thrombosis in a 32-year-old HIV-positive woman. Contrast-enhanced CT scan at the level of the aortic bifurcation shows filling defects as areas of abnormally low attenuation in both iliac veins (arrow).
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Figure 13. Venous thrombosis in a 40-year-old HIV-positive woman with miliary tuberculosis. Real-time gray-scale longitudinal ultrasonographic image shows an extensive thrombus (arrows) in the right common femoral vein.
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Figure 14a. Pulmonary embolism and infarction in a 50-year-old man with AIDS. (a) Conventional radiograph shows an abnormal pleura-based triangular parenchymal opacity in the left middle and lower lung zones (Hampton hump) (arrow), a finding that represented acute embolism. The patient died shortly after the examination. (b, c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) (b) and photograph (c) of a gross specimen depict a thromboembolus and a hemorrhagic infarct in the lower lobe of the left lung.
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Figure 14b. Pulmonary embolism and infarction in a 50-year-old man with AIDS. (a) Conventional radiograph shows an abnormal pleura-based triangular parenchymal opacity in the left middle and lower lung zones (Hampton hump) (arrow), a finding that represented acute embolism. The patient died shortly after the examination. (b, c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) (b) and photograph (c) of a gross specimen depict a thromboembolus and a hemorrhagic infarct in the lower lobe of the left lung.
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Figure 14c. Pulmonary embolism and infarction in a 50-year-old man with AIDS. (a) Conventional radiograph shows an abnormal pleura-based triangular parenchymal opacity in the left middle and lower lung zones (Hampton hump) (arrow), a finding that represented acute embolism. The patient died shortly after the examination. (b, c) Photomicrograph (original magnification, x10; hematoxylin-eosin stain) (b) and photograph (c) of a gross specimen depict a thromboembolus and a hemorrhagic infarct in the lower lobe of the left lung.
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Figure 15a. Bilateral pulmonary embolism in a 46-year-old HIV-positive man with pulmonary hypertension and emphysema. Contrast-enhanced chest CT scans (a at a higher level than b) show bilateral pulmonary embolisms (arrows).
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Figure 15b. Bilateral pulmonary embolism in a 46-year-old HIV-positive man with pulmonary hypertension and emphysema. Contrast-enhanced chest CT scans (a at a higher level than b) show bilateral pulmonary embolisms (arrows).
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Figure 16a. Pulmonary hypertension in a 32-year-old woman with pulmonary tuberculosis and Streptococcus-induced pneumonia. (a) Conventional radiograph shows abnormal prominence of the right interlobar pulmonary artery (19 mm) and prominence of the main trunk of the pulmonary artery (arrow), as well as parenchymal consolidation in the lower lobe of the left lung. (b) Contrast-enhanced CT scan depicts the abnormal prominence of the main trunk of the pulmonary artery (35 mm) (straight arrow), enlarged hilar and subcarinal lymph nodes (arrowheads), and a region of opacity that indicates pleural fluid in the lower lobe of the left lung (curved arrow).
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Figure 16b. Pulmonary hypertension in a 32-year-old woman with pulmonary tuberculosis and Streptococcus-induced pneumonia. (a) Conventional radiograph shows abnormal prominence of the right interlobar pulmonary artery (19 mm) and prominence of the main trunk of the pulmonary artery (arrow), as well as parenchymal consolidation in the lower lobe of the left lung. (b) Contrast-enhanced CT scan depicts the abnormal prominence of the main trunk of the pulmonary artery (35 mm) (straight arrow), enlarged hilar and subcarinal lymph nodes (arrowheads), and a region of opacity that indicates pleural fluid in the lower lobe of the left lung (curved arrow).
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Figure 17a. HIV-associated pulmonary hypertension in a 36-year-old man. (a) Apical four-chamber view of the heart depicts marked enlargement of the right-sided chambers, with a right ventricular diameter almost twice the diameter of the left ventricle. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle. (b) Parasternal short-axis echocardiographic view shows the enlarged right ventricle and paradoxical movement of the interventricular septum because of extremely high pressure. Flattening of the septum at the end of systole gives the left ventricle the appearance of the letter D. The systolic pulmonary artery pressure in this patient was more than 90 mm Hg. LV = left ventricle, RV = right ventricle.
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Figure 17b. HIV-associated pulmonary hypertension in a 36-year-old man. (a) Apical four-chamber view of the heart depicts marked enlargement of the right-sided chambers, with a right ventricular diameter almost twice the diameter of the left ventricle. LA = left atrium, LV = left ventricle, RA = right atrium, RV = right ventricle. (b) Parasternal short-axis echocardiographic view shows the enlarged right ventricle and paradoxical movement of the interventricular septum because of extremely high pressure. Flattening of the septum at the end of systole gives the left ventricle the appearance of the letter D. The systolic pulmonary artery pressure in this patient was more than 90 mm Hg. LV = left ventricle, RV = right ventricle.
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Figure 18. Systemic Kaposi sarcoma with pulmonary involvement and presumed cardiac involvement in a 40-year-old man. Conventional radiograph of the chest shows extensive bilateral pulmonary opacities in a patient with proved Kaposi sarcoma of the lung, skin, and abdomen, as well as dilated cardiomyopathy, which was refractory to different therapies and because of which cardiac involvement was suspected.
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Figure 19. Non-Hodgkin lymphoma in a young man with AIDS. Gross autopsy specimen shows extensive infiltration in the right ventricle (long white arrow), interventricular septum (black arrow), and inferior wall of the left ventricle (short white arrow).
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Figure 20a. Non-Hodgkin lymphoma in an HIV-positive patient. (a) Parasternal long-axis echocardiographic view shows a cardiac mass that involves the left atrium (white arrow) and left ventricle (black arrow), as well as a medium-sized pericardial effusion. (b) Apical two-chamber echocardiographic view depicts involvement of the mediastinum, left atrium, and epicardium (arrows) and a moderate-sized pericardial effusion (arrowheads).
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Figure 20b. Non-Hodgkin lymphoma in an HIV-positive patient. (a) Parasternal long-axis echocardiographic view shows a cardiac mass that involves the left atrium (white arrow) and left ventricle (black arrow), as well as a medium-sized pericardial effusion. (b) Apical two-chamber echocardiographic view depicts involvement of the mediastinum, left atrium, and epicardium (arrows) and a moderate-sized pericardial effusion (arrowheads).
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Figure 21. Cardiac involvement in non-Hodgkin B-cell lymphoma. Contrast-enhanced CT scan in a 28-year-old man with AIDS shows abnormal irregular thickening of the lateral wall of the left ventricle (arrow) and interatrial wall (arrowheads).
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Figure 22a. Cardiac involvement in non-Hodgkin B-cell lymphoma. (22a) Contrast-enhanced CT scan at the level of the heart in a 31-year-old man with AIDS shows a large mass, with subtle heterogeneous enhancement, that has infiltrated the right atrium (arrow) as well as the left atrium. (22b) Contrast-enhanced CT scan at a slightly lower level demonstrates abnormal thickening of the lateral wall of the left ventricle (arrow). (22c) Photograph of a gross autopsy specimen shows the irregular and infiltrative appearance of the malignant cardiac tumor.
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Figure 22b. Cardiac involvement in non-Hodgkin B-cell lymphoma. (22a) Contrast-enhanced CT scan at the level of the heart in a 31-year-old man with AIDS shows a large mass, with subtle heterogeneous enhancement, that has infiltrated the right atrium (arrow) as well as the left atrium. (22b) Contrast-enhanced CT scan at a slightly lower level demonstrates abnormal thickening of the lateral wall of the left ventricle (arrow). (22c) Photograph of a gross autopsy specimen shows the irregular and infiltrative appearance of the malignant cardiac tumor.
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Figure 22c. Cardiac involvement in non-Hodgkin B-cell lymphoma. (22a) Contrast-enhanced CT scan at the level of the heart in a 31-year-old man with AIDS shows a large mass, with subtle heterogeneous enhancement, that has infiltrated the right atrium (arrow) as well as the left atrium. (22b) Contrast-enhanced CT scan at a slightly lower level demonstrates abnormal thickening of the lateral wall of the left ventricle (arrow). (22c) Photograph of a gross autopsy specimen shows the irregular and infiltrative appearance of the malignant cardiac tumor.
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Copyright © 2006 by the Radiological Society of North America.
