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Weekly Chest CasesArchive of Old Cases

Case No : 618 Date 2009-08-30

  • Courtesy of Tae Hoon Kim, Sang Jin Kim / Gangnam Severance Hospital
  • Age/Sex 70 / M
  • Chief ComplaintCC : Fatigue, dyspnea, general weakness PHx : Chemotherapy due to lymphoma in tongue
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Pulmonary involvement of T cell lymphoma
Radiologic Findings
Chest radiograph at admission showed ground glass opacity in both lower lung fields (Fig 1). Chest CT images also showed ground glass opacity in both lower lobes, with somewhat peripheral predominance in left lower lobe (Fig 2). Follow-up chest radiograph after 1 week showed the lesions to be aggravated with consolidations in both lung fields (Fig 3).
Brief Review
Pulmonary Involvement of T cell lymphoma
Diffuse large B-cell lymphoma in tongue was proved by biopsy in this patient. Therefore, the patient has been treated with chemotherapy. He complained dyspnea and general weakness for a few days before admission. Transbroncheal lung biopsy confirmed the diagnosis of pulmonary involvement of T cell lymphoma. Multifocal nodular infiltration of atypical lymphocytes showed immunoreactivity to CD3 and high Ki-67 labeling index (> 70%), consistent with pulmonary T cell lymphoma (Fig 4).
CT findings in patients with adult T-cell leukemia or lymphoma consisted mainly of ground-glass attenuation, centrilobular nodules, and thickening of the bronchovascular bundles in the peripheral lung. These findings, although nonspecific, are considered suggestive of thoracic involvement in patients with adult T-cell leukemia or lymphoma.
References
1. Thoracic CT findings of adult T-cell leukemia or lymphoma, AJR. 2004 Mar;182(3):761-7.
2. Refer to Case 7, Case 287.
Keywords
Lung, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 81

▶ Correct Answer : 3/81,  3.7%
  • - Seoul National University Hospital , Korea (South) Hye Jin Yoo
  • - Shinchon Severance Hospital , Korea (South) Ho-Joon Lee
  • - Beaulieu clinic Geneva , Switzerland gilles GENIN
▶ Correct Answer as Differential Diagnosis : 25/81,  30.9%
  • - Father Muller Medical College , Mangalore , India nabil mahmood
  • - McGill University Health Centre , Canada Amr Ajlan
  • - hospital Sao Paulo , Brazil israel missrie
  • - KMC,Manipal , India satish maddukuri
  • - Samsung Medical Center , Korea (South) Hye Sun Hwang
  • - SMC , Korea (South) Jihoon Cha
  • - NTUH , Taiwan Kuei-pin Chung
  • - PingTung Christian Hospital ,China Medical University ,Taiwan,R.O.C. , Taiwan Jun Jun Yeh
  • - Samsung Medical Center , Korea (South) Ju Won Lee
  • - Kashan University of Medical Sciences, kashan , Iran Ebrahim Razi
  • - IRSA La Rochelle France , France Denis Chabassiere
  • - Asan Medical Center , Korea (South) Hye Jeon Hwang
  • - Vital Imaging Centre, Mumbai,India , India Ganesh Agrawal
  • - Hospital Sotiria, Athens, Greece , Greece Vasilios Tzilas
  • - Homs National Hospital , Syria Rami Abou Zalaf
  • - Hopital du SacrCoeur , Canada Abraham Bohadana
  • - IRSA , France jean-luc BIGOT
  • - clinique de SAVOIE , France, Metropolitan gay-depassier philippe
  • - chp st martin , France Mariotte benoit
  • - Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
  • - All India Institute of medical sciences , India Justin Moses
  • - NASA SCANS , India RAKESH BHATIA
  • - Armed Forces Chun-Cheon Hospital , Korea (South) Chaehun Lim
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - EWHA WOMANS MOKDONG UNIVERSITY HOSPITAL , Korea (South) YOOKYUNG KIM
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