대한흉부영상의학회 Weekly Chest Cases

Case No : 907 Date 2015-03-16

Courtesy of Kun Young Lim, M.D., Hyae Young Kim, M.D., Soo Hyun Lee, M.D. / National Cancer Center, Korea
Age/Sex 54 / M
Chief ComplaintAbnormality on routine check up

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Diagnosis With Brief Discussion

Diagnosis: IgG4-related disease
Radiologic Findings: CT scans show thickening of the bronchial wall and peribronchial consolidation in the right lung. Hilar and right inferior interlobar LN enlargement is also noted. PET/CT scan reveals hypermetabolic peribronchial LNs and consolidation in the right lung.

Right lower lobe wedge resection was performed and pathology confirmed IgG4-related disease.
Brief Review: IgG4-related disease is characterized by extensive IgG4-positive lymphoplasmacytic infiltration of various organs. IgG4-related disease involving thoracic organs has been reported to manifest as interstitial pneumonia, inflammatory pseudotumor, mediastinal fibrosis, pleuritis and bronchial inflammation.
Based on computed tomography features, IgG4-related disease can be categorized into four subtypes: solid nodular, round-shaped ground-glass opacity, alveolar interstitial and bronchovascular.
Common radiologic findings include mediastinal lymphadenopathy and thickening of the perilymphatic interstitium, with or without subpleural and/or peribronchovascular consolidation. Major differential diagnoses include organizing pneumonia (bronchiolitis obliterans organizing pneumonia), lung cancer, malignant lymphoma and lymphoproliferative disorders such as multicentric Castleman disease.
Please refer to
References: 1. D. Inoue, Y. Zen, H. Abo,T. Gabata, H. Demachi, T. Kobayashi, et al. Immunoglobulin G4 related lung disease: CT findings with pathologic correlations. Radiology 2009; 251: 260-270.
2. J.H. Ryu, H. Sekiguchi and E.S. Yi Pulmonary manifestations of immunoglobulin G4-related sclerosing disease. Eur Respir J 2012; 39: 180–186
3. S.Matsui, A. Hebisawa, F. Sakai, H. Yamamoto, Y. Terasaki, Y. Kurihara, et al. Immunoglobulin G4-related lung disease: Clinicoradiological and pathological features. Respirology 2013; 18, 480–487
Keywords: Lung, Non-infectious inflammation, Immune,

No. of Applicants : 98

▶ Correct Answer : 7/98, 7.1%

- Dong-A University Hospital , Korea (South) Won Jin Choi
- Asan Medical Center , Korea (South) Hyung Jung Koo
- Asan Medical Center , Korea (South) Soyeoun Lim
- Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
- Asan Medical Center , Korea (South) , Korea (South) Han Na Lee
- Okayama University Hospital , Japan Toshiyuki Komaki
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim

▶ Correct Answer as Differential Diagnosis : 20/98, 20.4%

- Kyoto University , Japan Akihiko Sakata
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- University of Tsukuba Hospital , Japan Sodai Hoshiai
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
- Oita University, Faculty of Medicine , Japan Fumito Okada
- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Okinawa Kyodo Hospital , Japan Shoko Iraha
- Niigata University , Japan Atsushi Uehara
- Shiga University of Medical Science , Japan Akitoshi Inoue
- Niigata City General Hospital , Japan Takao Kiguchi
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
- Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
- IRSA La Rochelle , France Denis Chabassiere
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
- National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
- Gifu Central Hospital , Japan Haruo Watanabe
- Seoul National University Hospital , Korea (South) Sunkyung Jeon
- Onomichi municipal hospital , Japan Hirofumi Mifune

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 907 Date 2015-03-16

Discussion

No. of Applicants : 98