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Clinical Characteristics

At no time is there any pain from the nodules or edema. However, there is disability caused by the weight of the limbs, but the disease is a nuisance rather than a severe problem. This combination of edema and nodules is the most frequent non-AIDS presentation in the tropics (Fig. 42.6). It is worth noting that, in nontropical climates, edema is less consistent and more variable in its extent; if it is sought and found, it helps considerably in the differential diagnosis. The non-AIDS patients are generally in good health, and initially there are no specific complaints other than of the nodules and swelling. Eventually the disease becomes bilateral, although it is seldom symmetrical. The nodules spread up the legs towards the thighs and to the groin (Fig. 42.7). Patients may complain of local irritation, which may be present before a nodule is palpable. Many nodules are not palpable clinically and will be demonstrated only by angiography (see later). Some nodules may wither and angiography shows that their blood supply has been damaged, causing shrinkage of the tumor and sometimes leaving a residual scar.


Fig. 42.7A-D. Multiple nodules along the course of the veins of both legs (seen at autopsy). In (A) the inguinal lymph nodes are enlarged. In (B) there is associated edema in the left (nearest) thigh. (C) The right thigh is open to show multiple dark nodules throughout the subcutaneous tissues. Many such nodules cannot be palpated clinically but can be demonstrated by angiography. (D) Arteriography in a patient with multiple nodules along the thigh, showing tumor blushes. The examination also demonstrated Kaposi tumors within the lymph nodes.


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