Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Pyothorax-associated lymphoma
- Radiologic Findings
- Chest radiograph (Fig. 1) shows a large empyema with diffuse pleural calcification. Initial chest CT images (Fig. 2a) show chronic empyema and small pleural soft tissue lesion (<2 cm in size). After 3 months, follow-up chest CT images (Fig. 2b) show a remarkable enlargement of the prior pleural soft tissue lesion. In addition, PET-CT images (Fig. 3) also reveal the hypermetabolic pleural mass. Eventually, CT-guided biopsy for the pleural mass was performed for the pathologic diagnosis.
- Brief Review
- Pyothorax-associated lymphoma (PAL) is a distinctive type of malignant lymphoma of mostly B-cell nature, strongly associated with Epstein-Barr virus (EBV) infection. PAL develops usually in chronically inflamed tissue, and is defined as the malignant lymphoma developing under chronic inflammation such as chronic pyothorax. Nakatsuka et al. reported that the major computed tomography (CT) finding of PAS is a pleural mass.1 In the description of pleural lymphoma, Kunimasa et al. reported the “thoracic sandwich sign” which appears a large mass encasing the vessel structures.2 In the present case, contrast-enhanced chest CT image shows the patent right intercostal artery within the conglomerated pleural mass representing the “pleural sandwich sign”. So, several studies have suggested that this sign may be useful in the diagnosis of primary pleural lymphoma.2-3
- References
- 1. Nakatsuka S, Yao M, Hoshida Y, Yamamoto S, Iuchi K, Aozasa K. Pyothorax-associated lymphoma: a review of 106 cases. J Clin Oncol. 2002;20(20): pp. 4255-4260.
2. Kunimasa K, Jo T, Takaiwa T, Ishida T. Thoracic sandwich sign. Intern Med. 2011;50(22): pp. 2865.
3. Kim Y, Lee M, Ryu YJ, Cho MS. The pleural sandwich sign in two cases of primary pleural lymphoma. Korean J Radiol. 2015;16(1): pp. 213-216.
- Keywords
- Pleura, Lymphproliferative disorder,