대한흉부영상의학회 Weekly Chest Cases

Case No : 535 Date 2008-01-28

Courtesy of Yu- Whan Oh, MD, Soo-Youn Ham, MD. / Korea University, Anam Hospital, Korea.
Age/Sex 50 / F
Chief ComplaintIncidentally detected abnormal finding in screening exam

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Diagnosis With Brief Discussion

Diagnosis: Lung, RUL, wedge resection; Intrapulmonary lymph node
Radiologic Findings: Simple Radiography:
No remarkable evidence of active pulmonary infiltrations.
Pleural and mediastinal abnormalities are not definite.
CT scan:
Initial chest CT scan revealed non calcified subpleural nodule (8mm).
Follow up scan in 3mo showed no remarkable interval growth of RUL nodule.
Differential diagnoses include bronchioloaveolar carcinoma, atypical adenomatous hyperplasia, focal fibrosis
Wedge biopsy reveals intrapulmonary lymph node.
Brief Review: Intrapulmonary lymph node (IPLN) is in the differential diagnosis of small pulmonary nodules detected on computed tomography (CT)[1-4]. It is detected in lung cancer patients and those without lung cancer [2-4]. Bankoff et al. [5] and others reported that IPLN is usually 12 mm or smaller in diameter and is located in the subpleural portion of the lower lung [1-2].
CT findings of IPLN are not specific, the distinction from malignant nodules is difficult.
Other investigators reported interesting findings of IPLN using high-resolution CT (HRCT), such as an angular appearance in shape and linear opacities extending from the nodule[2,8,9].
References: 1. Ishikawa, Koizumi, Naoya, Morita, et al. Ultrasmall Intrapulmonary Lymph Node: Usual High-Resolution Computed Tomographic Findings With Histopathologic Correlation. J Comput Ass Tomogr. 2007 May-Jun;31(3):409-13.
2. Kradin RL, Spirn PW, Mark EJ. Intrapulmonary lymph nodes. Clinical, radiologic, and pathologic features. Chest. 1985;87:662-667.
3. Fujimoto N, Segewa Y, Takigawa N, et al. Two cases of intrapulmonary lymph node presenting as a peripheral nodular shadow: diagnostic differentiation from lung cancer. Lung Cancer. 1998;20:203-209.
4. Oshiro Y, Kusumoto M, Moriyama N, et al. Intrapulmonary lymph nodes: thin-section CT features of 19 nodules. J Comput Assist Tomogr. 2002;26:553-557.
5. Bankoff MS, McEniff NJ, Bhadelia RA, et al. Prevalence of pathologically proven intrapulmonary lymph nodes and their appearance on CT. AJR Am J Roentgenol. 1996;167:629-630.
6. Trapnell DH. Recognition and incidence of intrapulmonary lymph nodes. Thorax. 1964;19:44-50.
7. Kunitoh H, Eguchi K, Yamada K, et al. Intrapulmonary sublesions detected before surgery in patients with lung cancer. Cancer. 1992;70:1876-1879.
8. Awai K, Nishioka Y, Tachiyama Y. Intrapulmonary lymph node: findings on high-resolution CT scans. AJR Am J Roentgenol. 1993;161:208-209.
9. Hyodo T, Kanazawa S, Dendo S, et al. Intrapulmonary lymph nodes: thin-section CT findings, pathological findings, and CT differential diagnosis from pulmonary metastatic nodules. Acta Med Okayama. 2004;58:235-240.
Keywords: Lung, Lymphoid hyperplasia,

No. of Applicants : 51

▶ Correct Answer : 7/51, 13.7%

- Shinsegye Rad Clinic, Daegu, Korea Gi Beom Kim
- Yongsan Hospital, College of Medicine, Chung-Ang University, Korea Jae Seung Seo
- Riverside Radiology Associates, Columbus, Ohio, USA Sumit Seth
- Regional Imaging Riverina, Australia Rashid Hashmi
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Ultra Care Coimbatore, India Debabrata Das
- Aims, New Delhi, India Ashish Gupta

▶ Correct Answer as Differential Diagnosis : 3/51, 5.9%

- Medinova Diagnostics, Bheemavaram, AP., India Harsha Vardhan
- Oswal Cancer Hospital, Ludhiana, Punjab, India Lovkesh Mittal
- Hospital Sotiria, Athens, Greece Vasilios Tzilas

▶ Semi-Correct Answer : 41/51, 80.4%

- Shiga University of Medical, Japan Norihisa Nitta
- National Taiwan University Hospital, Taipei, Taiwan Chin Chung Shu
- KAUMS, Kashan, Iran Ebrahim Razi
- IRSA, La Rochelle, France Denis Chabassiere
- Osaka University, Japan Osamu Honda
- Yonsei University college of medicine Severance hospital, Seoul, Korea Hua Sun Kim
- Ondokuz Mayis University, Samsun Turkey Cetin Celenk
- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Bollineni superspeciality Hospital, nellore AP India P. Sreenath
- Lilavati Hospital & Rsearch Centre, Mumbai, India Mahavir Swami
- CHU de Poitiers, France Paul Ardilouze
- Armidale Radiology, Australia Saurabh Khandelwal
- Pittwater Radiology, Australia Julie Arora
- Dept. of radiology, Assam medicalcollege, Assam, India Karunakaran M
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- E-Da Hospital, Taiwan Yu-Feng Wei
- CHRU Lille hopital calmette, France Toledano Manuel
- Ryby hall clinic Pune, India Sudarshan Rawat
- Tri-Service General Hospital, Taiwan Tsun-Hou, Chang
- Saga University, Japan Ryoko Egashira
- Dongguk University International Hospital, Korea Hee Seok Choi
- Trakya University Edirne, Turkey Armagan Sarac
- Asan Medical Center, Korea Dae Yoon Kim
- Annecy, France Gilles Genin
- MD PG Resident, Pims Loni, Maharashtra, India Sushant Bhadane
- Hopital Nord - CHU St Etienne, France Romain Malezieux
- China Medical University, Taiwan Jun-Jun Yeh
- The Catholic University of Korea, St. Mary Han Na Kim
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Gimpo Woori Hospital, Korea Son Youl Lee
- EKH-Berlin, Germany Michael Weber
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- University of Virginia, USA Rachita Khot
- Az. Osped. Santa Maria - Terni, Italy Angelo Carloni
- Pulmonologist, Medical College Chest Hospital, Thrissur, Thrissur, India Raveendran T.K
- Jackson Memorial Hospital, Miami, Florida, USA N.B.S. Mani
- IRSA La Rochelle, France Jean-Luc Bigot
- Max Hospital, New Delhi, India Vickrant Malhotra
- Nassau, Bahamas Trupti Dabholkar
- CHU Grenoble, France Bing Fabrice
- catholic university of korea , Korea (South) hanna kim

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 535 Date 2008-01-28

Discussion

No. of Applicants : 51