대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Pulmonary nodular lymphoid hyperplasia

Radiologic Findings

Fig 1: Chest radiography shows a nodular opacity in the right upper lung field.
Fig 2: There was a poorly defined nodular ground glass opacity in the right upper lobe.
Fig 3-5: One year later, the lesion had increased in size, with slightly clearer demarcation. No enlarged lymph nodes were found in the thorax. Although not shown here, the lesion exhibited mild FDG uptake in the PET-CT.

Brief Review

Pulmonary nodular lymphoid hyperplasia (PNLH) formerly referred to as pseudolymphoma, is a rare benign lesion consisting of a localized reactive lymphoid proliferation. PNLH is composed of a polymorphous population of lymphoid cells (both B and T cells), multiple germinal centers, as well as infiltration and expansion of the alveolar interstitium by lymphocytes and plasma cells.
The most frequent radiologic manifestation of PNLH is a solitary nodule or a focal area of consolidation. The nodules or nodular areas of consolidation usually measure 2 to 5 cm in diameter and contain air bronchograms. Multiple nodules or regions of consolidation may be seen.
PNLH lesions show no invasion or destruction of the adjacent pleura or bronchus, a behavior often exhibited by malignant lymphoma. Mediastinal and hilar lymphadenopathy as well as pleural effusion are typically absent in PNLH, and if present should raise the possibility of lymphoma.
Differential diagnostic considerations for NLH include primary lung malignancy, metastasis, and primary pulmonary lymphoma. Definitive diagnosis and treatment is made with surgical resection.

References

1. Sirajuddin, A., Raparia, K., Lewis, V. A., Franks, T. J., Dhand, S., Galvin, J. R., & White, C. S. (2016). Primary pulmonary lymphoid lesions: radiologic and pathologic findings. Radiographics, 36(1), 53-70.
2. Webb, W. R., M

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