대한흉부영상의학회 Korean Society of Thoracic Radiology

대한흉부영상의학회 Weekly Case 메뉴

Close

대한흉부영상의학회 Weekly Case 검색
대한흉부영상의학회 Weekly Case 검색
Advanced Search..

Close

Weekly Chest CasesArchive of Old Cases

Case No : 656 Date 2010-05-24

  • Courtesy of Yun Hyeon Kim , Hyun Ju Seon , Song Choi, You Ri Choi / Chonnam National Univeristy Hospital, Korea
  • Age/Sex 74 / F
  • Chief ComplaintFever, dyspnea, left flank pain for 1 day
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Diffuse large B-cell lymphoma involving lung and descending colon
Radiologic Findings
A 74-year-old female admitted with fever, dyspnea, and left flank pain for one day. Chest CT shows homogeneous well defined multiple nodules in BLLs (Fig. 1). Chest CT with mediastinal setting reveals several homogemeous lymphadenopathies in both supraclavicular areas (Fig. 2). Abdominal CT was performed for evaluation of fever focus and left plank pain. Abdomen CT scan shows eccentric wall thickening with relative homogeneous enhancement in descending colon without obstruction (Fig. 3). Also there were multiple conglomerated lymphadenopathies in mesentery and left paraaortic area. Conoloscopy was done and pathologic diagnosis was diffuse large B-cell lymphoma.
Brief Review
The lymphomas are a diverse group of neoplastic disorder. There are divided into Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL). Further subdivisions depend on the histologic type. Intrathoracic involvement is more common in HL than NHL. Diffuse large B-cell lymphoma in the most common of the NHL. It can arise in lymph nodes or outside of the lymphatic system, in the GI tract, testes, thyroid, skin, breast, bone or brain.
Lymphoma may involve any nodal chain in the body, and enlarged nodes are most common manisfestation on CT scans. Regardless of the area of involvement, nodal involvement of lymphoma has attenuation similar to muscle and homogeneous attenuation on CT scan.
Involvement of the lung parenchyma at the time of initial diagnosis is more common in HL than NHL. The patterns of lymphomatous involvement of the lung parenchyma are variable. In a review of the CT findings in 31 patients with pulmonary parenchymal lymphoma, the most common CT findings were nodules or mass-like consolidation larger than 1 cm (68% of patients) and small nodules less than 1cm (61%). Other manifestations include GGO, thickening of the interlobular septa, and occasionally endobronchial lesions. One pattern consists of single or multiple nodules similar to those seen in metastatic disease. The other patterns consist of mediastinal of hilar adenopathy with direct extension along lymphatic vessel into the lung parenchyma.
Extranodal lymphoma in GI tract occurs in 10-30% of all patients with NHL. In contrast to adenocarcinoma arising from GI tract, lymphoma is more likely involve multiple and longer segments of gut and is less likely to cause bowel obstruction.
References
1. Lee KS. Non-Hodgkin’s lymphoma. In: Muller NL, Silva IS. Imaging of the chest. Saunders, Philadelphia, 2008 pp595-615.
2. CT of lymphoma: Spectrum of Disease. RadioGraphics 1991;11:647-669
3. Patters of Lymphadenopathy in Thoracic Malignancies RadioGraphics 2004;24:419-434
4. Lymphoma of the lung: CT Findings in 31 Patients. AJR 1991;156:711-714
Keywords
Lung, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 72

▶ Correct Answer : 36/72,  50.0%
  • - Hangang sacred heart hospital , Korea (South) You Mie Han
  • - Osaka University , Japan Osamu Honda
  • - Univ. of Miami/Jackson Memorial , United States mantosh rattan
  • - Youngdong Hospital , Korea (South) Sang Min Lee
  • - CHUV , Switzerland ANNE-SOPHIE KNOEPFLI
  • - kyungpook national university hospital , Korea (South) jiwon park
  • - CHU NANCY , France, Metropolitan GREGORY LESANNE
  • - Yonsei University College of Medicine, Shinchon Severance hospital , Korea (South) Young Joo Suh
  • - Hospital M de Deus , Brazil Thiago Bento da Silva
  • - SoonChunHyang univ. hospital , Korea (South) Kim Jae Hyun
  • - hospital clinico universidad de chile , Chile fernando gonzalez
  • - Song-do Hospital , Korea (South) Ji-young Yun
  • - Nonsan Hospital , Korea (South) Eun-Tae Park
  • - HOSPITAL SOTIRIA , Greece AIKATERINI DELAVERI
  • - Seoul Veterans Hospital , Korea (South) Hye Sun Hwang
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Soonchunhyang university hospital, Bucheon , Korea (South) Hyelin Kim
  • - Inha University Hospital , Korea (South) Ju Won Lee
  • - Department of Radiology, Zhongshan Hospital, Fudan University,Shanghai, People , China Sheng-Xiang RAO
  • - royal melbourne hospital , Australia kimchi kings
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - CHUV , Switzerland Philipp Rau
  • - Bundang CHA hospital , Korea (South) Jung Jin Young
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - IRCCS Istituto Oncologico - Bari , Italy Carlo Florio
  • - Hangang Sacred Heart Hospital , Korea (South) Eil Seong Lee
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Dong san medical center , Korea (South) Young-eun Bahn
  • - Toyama University Hospital, Laboratory of Pathology , Japan TOMONORI TANAKA
  • - jobless , France jean-baptiste Noel
  • - Hotel-Dieu Montreal , Canada nicolas gautier
  • - care hospital , India Chary D
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Yashoda Superspeciality hospital , India Pravin Mahadevappa
  • - seoul national university hospital , Korea (South) Ijin Joo
▶ Correct Answer as Differential Diagnosis : 16/72,  22.2%
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Radnet Teleradiology , Turkey Murat Ulusoy
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - SAISEIKAI KURIHASHI HOSPITAL , Japan YASUO OKUBO
  • - kfhu , Saudi Arabia hind alsaif
  • - Osaka University , Japan Hiromitsu Sumikawa
  • - Doctors Hospital , Bahamas muneesh sharma
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - NASA SCANS , India RAKESH BHATIA
  • - McGill University Health Center , Canada Alexandre Semionov
  • - All India Institute of Medical Sciences , India Ashish Gupta
  • - Trakya University School of Medicine , Turkey Umut Ugur
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
  • - All India Institute of medical sciences , India Justin Moses
  • Top
  • Back

Each Case of This Site Supplied by the Members of KSTR.
Copyright of the Images is in the KSTR and Original Supplier.
Current Editor : Sang Young Oh, M.D., Ph.D Email : sangyoung.oh@gmail.com

This website is optimized for IE 10 and above.