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Weekly Chest CasesArchive of Old Cases

Case No : 1020 Date 2017-05-15

  • Courtesy of Joon Chul Ra, Min Jae Cha / Chung-Ang University Hospital
  • Age/Sex 64 / M
  • Chief ComplaintLeft chest wall pain (onset: 2 years ago, aggravation: 1 month ago) History of pulmonary tuberculosis and tuberculous pleurisy (time of diagnosis unknown)
  • Figure 1
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Diagnosis With Brief Discussion

Diagnosis
Pyothorax-associated lymphoma (PAL), diffuse large B-cell lymphoma
Radiologic Findings
Plain chest radiograph shows increased opacity with multiple calcifications, occupying almost the entire left hemithorax. Chest CT demonstrates volume decrease of left hemithorax with passive atelectasis of left lung. Left pleural effusion with diffuse, irregular pleural thickening and calcification is noted. Nodular and mass-like soft tissue lesions are formed along the thickened pleura and shows enhancement after contrast injection. Soft tissue masses invades left lateral chest wall, destroying left 5th and 6th ribs.
Brief Review
Pyothorax-associated lymphoma (PAL) is a rare type of lymphoma that typically occurs in patients who have undergone artificial pneumothorax therapy for tuberculosis. Mean age at diagnosis of PAL is approximately 60 years, and there is a male predilection. Current pathophysiologic understanding of the disease suggests that both chronic Epstein-Barr virus (EBV) infection and an immunocompromised condition from long-standing chronic inflammation due to chronic empyema may be the causative mechanism. According to one study that reported CT findings of PAL in 21 patients, all patients showed coexistent empyema with calcifications and nearly all patients showed enhancing soft-tissue masses adjacent to the empyema. All masses were adjacent to the corner of the coexistent empyema, with most of them lenticular in shape. Chest wall invasion (75.0%) and rib involvement (65.0%) were common. Other sites of direct invasion were also present: lung parenchyma (25.0%), abdomen (25.0%), cervical soft tissues (10.0%), scapula (5.0%), and mediastinum and vertebra (5.0%).
References
1. Ueda, Takuya, et al. "Pyothorax-associated lymphoma: imaging findings." American Journal of Roentgenology 194.1 (2010): 76-84.
2. Nakatsuka, Shin-ichi, et al. "Pyothorax-associated lymphoma: a review of 106 cases." Journal of Clinical Oncology 20.20 (2002): 4255-4260.
Keywords
Pyothorax-associated lymphoma, Diffuse large B-cell lymphoma ,

No. of Applicants : 124

▶ Correct Answer : 72/124,  58.1%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Hyogo Prefectural Amagasaki General Medical Center , Japan TOMOAKI OTANI
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - Showa university Northern Yokohama Hospital , Japan KOTA WATANABE
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Ibaraki Prefectural Central Hospital , Japan Shioto Oda
  • - NIMS, Hyderabad , India AMIT DADHANIA
  • - King Abdulaziz University Hospital , Saudi Arabia Amr M. Ajlan
  • - Gifu University Hospital , Japan TOMOHIRO ANDO
  • - , Canada ASHISH GUPTA
  • - NIMS, HYDERABAD , India BHASKAR K
  • - Seoul Medical Center , Korea (South) TAERAN AHN
  • - Korea University Guro Hospital , Korea (South) Bit Na Park
  • - Korea University Guro Hospital , Korea (South) PARK SOYEON
  • - The University of Tokyo Hospital , Japan Yusuke Watanabe
  • - Korea University Guro Hospital , Korea (South) SOO YOUNG CHAE
  • - Chungbuk National University Hospital , Korea (South) SOOJUNG LEE
  • - Seoul National University Hospital , Korea (South) SU YEON AHN
  • - Busan National University Hospital , Korea (South) ILWAN SON
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Seoul National University Hospital , Korea (South) SIWON JANG
  • - Asan Medical Center , Korea (South) HYUN JUNG KOO
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - privato , Italy VINCENZO ENZO GENCHI
  • - Chonnam National University Hospital , Korea (South) GUNSU KIM
  • - The Jikei university , Japan TAKU GOMI
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - Yonsei University, Wonju Severance Christian Hospital , Korea (South) JUYEON LEE
  • - Chonnam National University Hospital , Korea (South) JONG HYEON KIM
  • - Seoul National University Hospital , Korea (South) JI EUN KIM
  • - Chung buk national university hospital , Korea (South) hong gwon Byun
  • - Gifu University Hospital , Japan Yo Kaneko
  • - Chungbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - Samsung Medical Center , Korea (South) MIN YEONG KIM
  • - Okayama Red Cross Hospital , Japan KAZUAKI MUNETOMO
  • - Dong-A University, College of Medicine , Korea (South) KI-NAM LEE
  • - , United Kingdom KRISHNA PRASAD PREMNATH BELLAM
  • - Samsung medical center , Korea (South) Ran Kim
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Samsung Medical Center , Korea (South) KYOWON GU
  • - Medicheck health care , Korea (South) Chae hun Lim
  • - Chonbuk National University Hospital , Korea (South) WON HYEONG IM
  • - Mallinckrodt Institute of Radiology , United States Naganathan BS Mani
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Soonchunhyang University Hospital Seoul , Korea (South) BODA NAM
  • - Chungbuk national university hospital , Korea (South) Miran Yeon Yeon
  • - Azienda Ospedaliera di Cremona , Italy Pietro Sergio
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - GHICL , France MANUEL TOLEDANO
  • - The University of Tokyo Hospital , Japan TAKU TAJIMA
  • - , Korea (South) JEONGBIN PARK
  • - Yujin Yamazaki Hospital , Japan MASASHI TAKAHASHI
  • - Max Hospital New Delhi , India RAJESH GOTHI
  • - Other , Korea (South) DONGHWAN KIM
  • - Korea university medical center, guro hospital , Korea (South) Lee kyu chong
  • - Korea University Guro Hospital , Korea (South) JINWOO HAN
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - Korea University Guro Hospital , Korea (South) SUN HONG
  • - Teikyo University Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - Seoul National University Hospital , Korea (South) YONSUB SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - University of Utah , United States AKIHIKO SAKATA
  • - Pusan national university hospital , Korea (South) So min Park
  • - Manipal hospitals , India ELAKYA ARUL
  • - Chungbuk National University Hospital , Korea (South) HYEONMI RYU
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
▶ Correct Answer as Differential Diagnosis : 17/124,  13.7%
  • - staten island univ hosp , United States JOSEPH LOWRY
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Chungbuk National University Hospital , Korea (South) YEONGTAE PARK
  • - Ondokuz Mayis University , Turkey CETIN CELENK
  • - Other , Korea (South) SEONG SU KANG
  • - Amagasaki General Medical Center , Japan GENKI FUKUMOTO
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Asan Medical Center , Korea (South) JIHYE KWON
  • - Asan Medical Center , Korea (South) JOOAE CHOE
  • - Chungbuk National University Hospital , Korea (South) LEE JUNG HWAN
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
  • - Other , Korea (South) HAYEON LEE
  • - Kyeongpook National University Hospital , Korea (South) SUNGJUN MOON
  • - The University of Tokyo Hospital , Japan HIROSHI TAKUMIDA
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
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