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Weekly Chest CasesArchive of Old Cases

Case No : 938 Date 2015-10-19

  • Courtesy of Sung Ho Hwang, Yu-Whan Oh, Soo-Youn Ham / Korea University Anam Hospital
  • Age/Sex 77 / M
  • Chief ComplaintPleuritic chest pain
  • Figure 1
  • Figure 2
  • Figure 3

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,

No. of Applicants : 91

▶ Correct Answer : 58/91,  63.7%
  • - Kyoto University , Japan Akihiko Sakata
  • - Juntendo University Hospital , Japan Akifumi Hagiwara
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - Himeji Redcross Hospital , Japan Soichiro Okamoto
  • - Daejin Medical Center Bundang Jesaeng General Hospital , Korea (South) Donghwan Kim
  • - Armed Forces Seoul Hospital , Korea (South) Eui Jin Hwang
  • - University of British Columbia , Canada Amr Ajlan
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Government Medical College, Nagpur, India , India Krishna Prasad Bellam
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - privato , Italy genchi enzo
  • - GHICL , France manuel toledano
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - The University of Tokyo Hospital , Japan Toshihiro Furuta
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - McGill University Health Center , Canada Matthieu Storme
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - University of Tsukuba , Japan Hiroaki Takahashi
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - , Korea (South) Kim sungmo
  • - chonnam national university hospital , Korea (South) Kim eun
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - Chonnam Nationl University Radiology , Korea (South) juwon kim
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - Asan Medical Center , Korea (South) Hyung Jung Koo
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Teikyo University Mizonokuchi Hospital , Japan Noriko Kobayashi
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Niigata University , Japan Atsushi Uehara
  • - kangbuk samsung , Korea (South) jihyun kim
  • - Private sector , Greece Vasilios Tzilas
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - the first affiliatited hospital of nanjing medical univercity , China Hai Xu
  • - Ajou University Hospital , Korea (South) Taeyang Ha
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - Hanyang University Guri Hospital , Korea (South) Seung Hyun Kim
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Shiga University of Medical Science , Japan Akitoshi Inoue
  • - Hallym University Kangnam Sacred Heart Hospital , Korea (South) Jung Youn Kim
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - seoul national university hospital , Korea (South) yunsoo jeong
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Asan , Korea (South) Sania ALBlushi
  • - IRSA La Rochelle , France Denis Chabassiere
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Santosh hospital,Bengaluru , India Pravin Mahadevappa
  • - Chonnam national university hospital , Korea (South) INSOO JANG
  • - PNUH , Korea (South) Seungbaek Hong
▶ Correct Answer as Differential Diagnosis : 14/91,  15.4%
  • - Tashkent Medical Academy , Uzbekistan Rustam Fayzullaev
  • - McGill University Health Center , Canada Alexandre Semionov
  • - pusan national university hospital , Korea (South) kim jeongmyeong
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - Ajou University Hospital , Korea (South) Seulgi You
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - NASA SCANS , India RAKESH BHATIA
  • - chp st martin , France Mariotte benoit
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - Nasaret Hospital , Korea (South) Hee Seok Choi
  • - Kinki University Faculty of Medicine, , Japan Mitsuru Matsuki
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