Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Diffuse large B-cell lymphoma associated with chronic empyema
- Radiologic Findings
- Figs 1, 2. CT scans show chronic empyema with pleural calcification and soft tissue mass in the right hemithorax.
Fig 3, 4. PET-CT images show hypermetabolic nodular lesions along the pleura in the right hemithorax.
- Brief Review
- The occurrence of a malignant neoplasm originating from a chronic inflammatory condition in the pleural space is a rare but critical complication of chronic empyema.
The prevalence of pyothorax-associated lymphoma (PAL) is higher in Asia, especially Japan, than elsewhere, and PAL is strongly associated with Epstein-Barr virus (EBV) infection.
PAL commonly demonstrates a lenticular or crescent-shaped soft-tissue mass straddling the thickened pleura at the margin of a coexistent empyema cavity. The lesion has a tendency to invade adjacent structures, the exact structures depending on the anatomic location of the empyema. Frequent sites of invasion are the chest wall, rib, and lung, when the tumor is located at the lateral costal pleura. A less frequent site is the abdomen through the diaphragm, when the empyema is in the costophrenic angle or along the diaphragm. CT frequently depicts air–fluid levels or air bubble formation in the empyema cavity, and these signs may be associated with fistula formation caused by the tumor invasion. Fistula formation can also occur in chronic empyema without a tumor but is not common.
- Please refer to
Case 938, Case 874, Case 460, -
KSTR Imaging Conference 2014 Summer Case 1
,
KSTR Imaging Conference 2009 Spring Case 5
,
KSTR Imaging conference 2009 Summer Case 4,
- References
- 1. Lee HY, Goo JM, Lee HJ et al. The value of computed tomography for predicting empyema-associated malignancy. JCAT 2006;30:453-459
2. Ueda T, Andreas C, Itami J et al. Pyothorax-Associated Lymphoma:Imaging Findings. AJR 2010;194:76-84
- Keywords
- Pleura, Neoplasm, Malignant neoplasm,