대한흉부영상의학회 Weekly Chest Cases

Case No : 869 Date 2014-06-23

Courtesy of Sang Hyun Paik / Soonchunhyang University Hospital Bucheon
Age/Sex 58 / F
Chief ComplaintDyspnea for 1 month

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Diagnosis With Brief Discussion

Diagnosis: Diffuse large B cell lymphoma
Radiologic Findings: There are diffusely increased GGO and consolidation in both lungs, predominantly in the BUL. The consolidation and GGO are more prominent in peripheral portion of both lungs, but they preserve subplerual region.
There are interlobular septal thickening in the BUL, which is smooth and diffuse. But axial interstitial thickening is not definite.
In the abdomen CT scan (portal phase), there are ill-defined soft tissue attenuated lesion and fat infiltration along the retroperitoneum and bilateral perinephric spaces. Also, irregular nodular lesion or LN is noted in aortocaval and left paraaortic area.
CT-guided needle bioposy was performed.
Brief Review: In this case, lymphoma represented as multifocal airspace consolidation. In many literatures, lung involvement of lymphoma presents many kinds of disease pattern such as nodules, GGO, interlobular septal thickening, and airspace consolidations. And also many cases of pulmonary lymphoma shows with or without mediastinal lymphadenopathy. However in this case there seldom found mediastinal lymphadenitis despite bilateral large consolidations. And there were several retroperitoneal soft tissue attenuation and lymph nodes on abdomen CT.
Primary pulmonary lymphoma represent only 0.5% of all pulmonary lung neoplasm. It usually present with localized areas of consolidation on chest radiographs and CT scans. Air-bronchograms are commonly present. Less-common radiographic patterns of primary lymphoma of the lung include nodules, diffuse bilateral airspace consolidation, and segment or lobar atelectasis. Pleural involvement is rare.
Recurrent or secondary pulmonary involvement is much common and originates from nodal or extrathoracic lymphoma. Non-Hodgkin lymphoma is the commonest type of lymphoma overall, mainly represented by the multiple mature B-cell subtypes. Nearly half of these patients have intrathoracic disease at presentation. It may result from direct mediastinal node extension, from lymphatic or hematogenous dissemination from distant sites, or from parenchymal lymphoid tissues. Bronchovascular extension of mediastinal and hilar disease occurs most frequently and result in a reticulonocular pattern. On radiologic findings, there ar various patterns: bronchovascular or lymphangitic with thickening of bronchovascular bundles and interlobular septa, discrete pulmonary nodules, pneumonic or alveolar with areas of consolidation, and military or hematogenous with disseminated micronodules.
References: 1.Imaging of pulmonary lymphomas. AJR Am J Roentgenol 1997;168:339-345
2. The radiological spectrum of pulmonary lymphoproliverative disease. Br J Radiol. Jul 2012;85(1015):848-864
Keywords: Lung, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 93

▶ Correct Answer : 3/93, 3.2%

- The University of Tokyo Hospital , Japan Takeyuki Watadani
- Kizawa Memorial Hospital , Japan Yo Kaneko
- Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA

▶ Correct Answer as Differential Diagnosis : 30/93, 32.3%

- Niigata City General Hospital , Japan Takao Kiguchi
- kasturba medical college , India mugil varman
- McGill University Health Center , Canada Alexandre Semionov
- GTHTM , India Ramesh M
- IRSA La Rochelle , France Denis Chabassiere
- Severance hospital , Korea (South) Bio Joo
- Oita University, Faculty of Medicine , Japan Fumito Okada
- Royal Perth Hospital , Australia Yuranga Weerakkody
- Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
- Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
- National Hospital Organization Okinawa Hospital , Japan Yasuji Oshiro
- Ondokuz Mayis University , Turkey Cetin Celenk
- PGIMER , India Karthik r
- Jichi Medical University Hospital , Japan Yuichiro Kawahara
- Medical College Chest Hospital,Thrissur,Kerala , India Raveendran TK
- Shiga University of Medical Science , Japan Akitoshi Inoue
- 異⑸ , China ZHANG YING
- DELTA CARE HOSPITAL, THANJAVUR, INDIA , India SIVARAJA SUBRAMANIAM
- Kyoto University , Japan Akihiko Sakata
- The University of Tokyo Hospital , Japan Toshihiro Furuta
- Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
- CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
- Kobe City Medical Center General Hospital , Japan Yasuhisa Kurata
- Onomichi municipal hospital , Japan Toshiyuki Komaki
- jaslok hospital & research centre mumbai , India JAINENDRA JAIN
- Mallinckrodt Institute of Radiology , United States Naganathan Mani
- Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
- NASA SCANS , India RAKESH BHATIA
- Oita University , Japan Haruka Sato
- The University of Tokyo Hospital , Japan Takana Yamakawa

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 869 Date 2014-06-23

Discussion

No. of Applicants : 93