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Weekly Chest CasesArchive of Old Cases

Case No : 1052 Date 2017-12-25

  • Courtesy of Kun Young Lim, MD, Hyae Young Kim, MD, Soo Hyun Lee, MD / National Cancer Center, Korea
  • Age/Sex 72 / M
  • Chief ComplaintChanges in CT findings during follow-up
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

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,

No. of Applicants : 98

▶ Correct Answer : 73/98,  74.5%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - staten island univ hosp , United States JOSEPH LOWRY
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Higashi-Ohmi General Medical Center , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Ajou university hospital , Korea (South) Pae Sun Suh
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Apollo Hospitals , India SAMSON KADE
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) HAYEON LEE
  • - Seoul National University Hospital , Korea (South) Ju Gang Nam
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - 罹…stanbul , Turkey AYHAN YILMAZ
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - privato , Italy VINCENZO ENZO GENCHI
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Seoul National University Hospital , Korea (South) HYOUNG IN CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Other , Korea (South) HYUNGWOO OH
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Gifu University Hospital , Japan Yo Kaneko
  • - VDC, HYDERABAD , India KARTHIK RAYASAM
  • - Graduate school of Medical Sciences, International University of Health and Welfare , Japan SHIGERU KIRYU
  • - Okayama Red Cross Hospital , Japan KAZUAKI MUNETOMO
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - Kurashiki Central Hospital , Japan TORU KONISHI
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - 怨„紐… , Korea (South) jin young kim
  • - University of Tsukuba Hospital , Japan HIROAKI TAKAHASHI
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - CLINIQUE STE CLOTILDE , Reunion PATRICK MASCAREL
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) SEONGSU KANG
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Maimonides Medical Center , United States NAOMI TWERSKY
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - , Korea (South) JANG SEONG WON
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - DECRH, Fredericton , Canada RAM P GALWA
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Chonnam National University Hospital , Korea (South) BYEONGHAK SIM
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Ajou University Hospital , Korea (South) SUBIN HEO
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Kyoto Prefectural University of Medicine , Japan TADASHI TANAKA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) YONGSUB SONG
  • - hamamatsu university school of medicine , Japan YUKI HAYASHI
  • - University of Utah , United States AKIHIKO SAKATA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Kyemyung University Dongsan Hospital , Korea (South) DONG HYEON KIM
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - Samsung Medical Center , Korea (South) HYUN JUNG YOON
  • - Ajou University Hospital , Korea (South) YOO YOUNGJIN
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 6/98,  6.1%
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - HHS , Canada S LEE
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
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