대한흉부영상의학회 Korean Society of Thoracic Radiology

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Weekly Chest CasesCases by Disease Category

Case No : 1306 Date 2022-10-31

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  • Courtesy of Sung Ho Hwang, Yu-Whan Oh / Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
  • Age/Sex 49 / M
  • Chief Complaintleft pleural effusion.
  • Figure 1
  • Figure 2
  • Figure 3

Diagnosis With Brief Discussion

Diagnosis
Pleural lymphoma
Radiologic Findings
Chest radiography (Fig. 1) shows a large amount of left pleural effusion.
Contrast-enhanced axial CT (Fig. 2) demonstrates a left pleural effusion and pleural mass (arrow). Intercostal artery is enveloped by the pleural mass.
F-18 fluorodeoxyglucose positron emission tomography (Fig. 3) shows multiple pleural lesions of hypermetabolism.
Brief Review
Primary pleural lymphoma is rare, although pleural effusion and pleural mass are common manifestations of secondary lymphoma. Usually, primary pleural lymphoma appears as diffuse nodular pleural thickening and localized mass.
Beyond the pleural mass itself, intercostal arteries can be well visualized in the conglomerated pleural masses on axial contrast-enhanced CT images, representing the "pleural sandwich sign". This sign has not been reported in other pleural tumors, including metastases, malignant mesothelioma, and solitary fibrous tumors invading the intercostal vessels. Therefore, this characteristic CT sign would be helpful to differentiate primary pleural lymphoma from other pleural tumors.
References
1. Yookyung Kim, Myungjae Lee, Yon Ju Ryu, et al. The Pleural Sandwich Sign in Two Cases of Primary Pleural Lymphoma. Korean J Radiol. 2015; 16(1):213-216
Keywords
Pleural lymphoma ,

No. of Applicants : 86

▶ Correct Answer : 31/86,  36.0%
  • - Jichi Medical University Hospital , Japan JUN KANZAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Showa General Hospital , Japan MASAFUMI KAIUME
  • - Hpital du Sacr Coeur , Canada Andrea Ojanguren
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - NIMS, HYDERABAD , India BHASKAR K
  • - IRSA LA ROCHELLE , France JEAN LUC BIGOT
  • - Seoul National University Hospital , Korea (South) HYUNGIN PARK
  • - , Italy PAOLO BALDASSARI
  • - Other , Korea (South) SEONGSU KANG
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Osaka University , Japan AKINORI HATA
  • - Ajou University Hospital , Korea (South) HAEIN LEE
  • - Ajou University Hospital , Korea (South) HYUNSEUNG LEE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - Chungbuk National University Hospital , Korea (South) MIHYEON PARK
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Chonnam National University Hwasun Hospital , Korea (South) JEONG YEOP LEE
  • - Other , Korea (South) KYU-CHONG LEE
  • - , Japan KENSUKE DOMAE
  • - , Japan MATSUNO MAI
  • - Kyoto University Hospital , Japan SATOSHI IKEDA
  • - Nerimahikarigaoka hospital , Japan TAKANA HAYASHI
  • - , Japan YUKI HAYASHI
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 27/86,  31.4%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - , Japan KYOKO NAGAI
  • - , Japan MASAKI UMEHANA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
  • - National Center of Neurology and Psychiatry , Japan MOTO NAKAYA
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - , Korea (South) JIN YOUNG LEE
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Shimada General Medical Center , Japan HAYATO NOZAWA
  • - Yamanashi Prefectural Central Hospital , Japan HIROAKI WATANABE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Kyoto University Hospital , Japan YASUHISA KURATA
  • - , United States HIROAKI TAKAHASHI
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Pusan National University Yangsan Hospital , Korea (South) JI HWAN KIM
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
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