대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Courtesy

Korea University Guro Hospital

Imaging Findings

Chest radiograph shows a mass in LLL superior segment and multiple variable sized nodules or focal consolidations are scattered in both lungs. Small pleural effusions are also noted in both sides. On CT scans, a 3.5 cm sized mass is seen in LLL superior segment with segmental bronchial occlusion. Several nodules and consolidation with/without internal air-bronchograms are seen in both lungs. There is no lymphadenopathy in mediastinum.

On bronchoscopy, diffuse narrowing of bronchi with infiltrative nodular mucosa is seen on LLL bronchus. Lymphoma, diffuse large B cell type, was confirmed from bronchoscopic biopsy specimen on LLL. The patient refused further systemic review and treatment, and the involvement of other organ couldn’t be evaluated.

Discussion

Primary pulmonary lymphoma
Lymphoma is limited to the lung with/without mediastinal lymph node involvement. No evidence of extrathoracic dissemination for at least 3 months after the initial diagnosis.
NHL, low-grade B-cell lymphoma (MALToma or BALToma)

Low-grade lymphoma:
more than 80% of primary pulmonary lymphoma.
Radiologic manifestations: solitary nodule, focal consolidation, multiple nodules, multifocal consolidations peribronchial in location. Air bronchogram in 50%.

Primary high-grade lymphoma: B-cell type.
Radiologic manifestations: solitary or multiple nodules. Lymph node enlargement may be present. Bilateral consolidation, diffuse reticulonodular pattern.

Secondary pulmonary lymphoma
More frequently than primary lymphoma of the lung.
Intrathoracic abnormalities at presentation: 67-87% of HD, 43-45% of NHL.
Pulmonary involvement at presentation: 5-10% of NHL, 10-15% with HD.
In HD, pulmonary involvement at presentation is almost always associated with hilar or mediastinal lymph node enlargement; this is not the case with NHL.

Radiologic manifestations:
HD and NHL are similar.
Solitary or multiple nodules, masses, mass like consolidation.
Air bronchograms are visible in 47% of NHL and 32% of HD.
Diffuse reticulonodular pattern, thickening of peribronchovascular interstitium, patchy air space consolidation.

Keywords

Lung, lymphproliferative disorder, Lymphoma,