대한흉부영상의학회 Korean Society of Thoracic Radiology

Discussion

Diagnosis With Brief Discussion

Diagnosis

Non-Hodgkin's Lymphoma (T-cell)

Radiologic Findings

Chest radiograph shows cardiomegaly and patchy opacity at left middle lung zone. Bilateral CPA blunting and obliteration of left hemidiaphragm are seen. On CT scan, soft tissue mass lesion is noted at mediastinum, diffusely infiltrating to mediastinum, anterior chest wall, paravertebra, retroperitoneum, and bilateral pleura. The mass encases heart and aorta. The lesion shows relatively homogenous attenuation with mild enhancement. Pericardial effusion and bilateral pleural effusion is noted. Bone marrow biopsy at iliac crest revealed bone marrow involvement of lymphoma.

Brief Review

The anterior mediastinal and paratracheal nodes are most frequently involved group of lymphoma. The great majority of cases of Hodgkin’s disease show enlargement of two or more nodal groups, whereas only one nodal group is involved in about half the cases of non-Hodgkin’s lymphoma. Hilar node enlargement is rare without accompanying mediastinal node enlargement. The posterior mediastinum is infrequently involved. Contiguous retroperitoneal disease is likely. The paracardiac nodes are rarely involved but become important as sites of recurrence because they may not be included in the radiation field. Compression of the pulmonary artery, SVC, and major bronchi within the mediastinum may be seen. At CT scaning the enlarged nodes in any of the malignant lymphoma may be discrete or matted together. Low-density areas resulting from cystic degeneration may be seen in both Hodgkin’s and non-Hodgkin’s lymphoma. CT scanning is more useful in the initial staging of Hodgkin’s disease than it is for non-Hodgkin’s lymphoma because radiation therapy to enlarged nodes is either the only treatment for Hodgkin’s disease or a major component of therapy. Non-Hodgkin’s lymphoma is often disseminated at the time of initial diagnosis and basic treatment for disseminated disease is chemotherapy.

References

Amstrong P. Neoplasms of the lungs, airways and pleura. In: Amstrong P, Wilson AG, Dee P, Hansell DM eds. Imaging of diseases of the chest. 2nd ed. Mosby 1995: 318-323

Keywords

Mediastinum, Lymphproliferative disorder, Non-Hodgkin's Lymphoma (T-cell)