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Patients with acquired immunodeficiency syndrome frequently develop complications of cardiac, pericardial, and thoracic vascular origin. The purpose of this pictorial essay is to review the most common etiologic and diagnostic imaging findings of these diseases. Patients with acquired immunodeficiency syndrome often demonstrate enlargement of the cardiac silhouette on the chest radiograph. While the cause of this finding may be clinically evident, the authors share cases in which chest computed tomography, echocardiography, and nuclear medicine studies better reveal the nature of underlying cardiac and pericardial abnormalities. Thoracic vascular complications, including pulmonary hypertension, pulmonary thromboembolism, and the sequelae of indwelling venous catheters, are also addressed.