대한흉부영상의학회 Weekly Chest Cases

Case No : 519 Date 2007-10-8

Courtesy of Jin Hur, MD, Byoung Wook Choi, MD, Ji Eun Nam, MD, Hye-Jeong Lee, MD, Kyu Ok Choe, MD. / Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Korea.
Age/Sex 37 / M
Chief ComplaintChest X-ray abnormality

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Diagnosis With Brief Discussion

Diagnosis: Castleman's disease, hyaline vascular type
Radiologic Findings: A well defined mass is noted in the left cardiac area, obscuring the border of the descending thoracic aorta on chest radiography.
Contrast enhanced chest CT images show that the 3.5cm-sized lobulating mass, abuts the left posterior pericardium, descending thoracic aorta and esophagus.
The mass shows relatively homogenous attenuation with contrast enhancement.
Axial FDG-PET image demonstrates increased FDG uptake corresponding to the mass on the CT images.
Brief Review: Castleman disease, also known as angiofollicular hyperplasia or giant lymph node hyperplasia, is a rare disorder of lymphoid tissue. This disease may occur anywhere along the lymphatic chain but it is most commonly found as a solitary mass in the mediastinum.
Two distinct histologic patterns of Castleman disease have been described, including the hyaline-vascular type, accounting for 90% of cases, and the remainder of cases as the plasma cell type, which is often associated with constitutional symptoms.
Three patterns have been reported on CT or MRI, including a solitary noninvasive mass (50%), like the present case, a dominant infiltrative mass with associated lymphadenopathy (40%), and a matted lymphadenopathy without a dominant mass (10%).
In Castleman disease, CT with contrast material usually shows a dense uniform enhancement. Dynamic CT demonstrates early rapid enhancement and washout in the delayed phase, which are considered as typical imaging characteristics that help to differentiate this disease from other mediastinal tumors, furthermore, peripheral hypervascularity is a characteristic finding on power Doppler ultrasonography. A punctate or arborizing pattern of calcification may be seen.
Some recent studies have reported a considerable number of cases showing heterogeneous attenuation. They reported that tumors greater than 5 cm in diameter generally demonstrate heterogeneous enhancement. In several studies, a focal low attenuation area within the mass showing delayed enhancement on dynamic CT or MRI, was pathologically proven to be central stellate fibrosis interspersed within the mass.
An MRI study has been reported to be useful for the evaluation of peripheral or tumoral hypervascularity and the relationship with adjacent vascular structures, because vascular structures appear signal void with high contrast to the mass. In the present case, double inversion recovery, so called 멳lack blood imaging뭮ith T1- or T2-weighted images, excellently demonstrated peripheral dilated and tortuous vascular structures.
References: 1. Moon WK, Im JG and Kim JS et al. Mediastinal Castleman disease: CT findings. J Comput Assist Tomogr 1994;18:43?6.
2. McAdams HP, Rosado-de-Christenson M, Fishback NF et al. Castleman disease of the thorax: radiologic features with clinical and histopathologic correlation. Radiology 1998;209:221?28.
3. Kim TJ, Han JK, Kim YH et al. Castleman disease of the abdomen: imaging spectrum and clinicopathologic correlations. J Comput Assist Tomogr 2001;25:207?14.
Keywords: Lung, Lymphproliferative disorder, Lymphoid hyperplasia,

No. of Applicants : 44

▶ Correct Answer as Differential Diagnosis : 6/44, 13.6%

- EKH-Berlin, Germany Michael Weber
- Regional Imaging Riverina, Australia Rashid Hashmi
- China Medical University Hospital, Taiwan Jun-Jun Yeh
- Annemasse, Polyclinique De Savoie, France Gay-Depassier Philippe
- IRSA La Rochelle, France Jean-Luc BIGOT
- Yongsan Hospital, Chung-Ang University, Seoul, Korea Jae Seung Seo

▶ Semi-Correct Answer : 31/44, 70.5%

- Dept. of radiology, Inje University Ilsan Paik Hospital, Korea Bae Geun Oh
- Shiga University of Medical, Japan Norihisa Nitta
- Registrar in Radiology, UHL NHS Trust, UK A. Donuru
- Pune, India Rahul Deshmukh
- Hospital Sotiria Athens Greece Delaveri kaith
- Kazipet, Warangal, AP, India Pavankumar Vodithala
- Kasturba Medical Collage, Manipal, Karnataka, India Naveen M Kulkarni
- Armidale Radiology, Australia Saurabh Khandelwal
- Pittwater Radiology, Australia Julie Arora
- Lilavati Hospital, Mumbai, India Mahavir Swami
- Asan medical center, Seoul, Korea Dae Yoon Kim
- Nirman Hitech centre, Malald, Apollo Clinic, Kandivali, Mumbai, India Jeshil R. Shah
- Vital imaging centre, Mumbai, India Ganesh Agrawal
- Princess margaret hospital, Nassau The Bahamas Sudheer Hegde
- Hangang Sacred Heart Hospital, Korea Eil Seong Lee
- Foch Hospital, Paris, France A. Hidar
- Samsung medical center, Korea Young A Bae
- Thoracic Imaging Section, Dept. of Radiological sciences, UCLA, USA Fereidoun Abtin
- Homs National Hospital, Homs - Syria Rami Abou Zalaf
- Jiangsu Province Official Hospital, Nanjing, Jiangsu Province, China Dong Sheng Jin
- Gimpo Woori Hospital, Korea Son Youl Lee
- Mackay Memorial Hospital, Taipei, Taiwan Chia-Fu Tsai
- Annecy hospital, France Gilles Genin
- IRSA, La Rochelle, France Denis Chabassiere
- Ultra Care, Coimbatore, India Debabrata Das
- Dept. of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India Ram Prakash Galwa
- Jackson Memorial Hospital, Florida, USA N.B.S.Mani
- Nassau, Bahamas Trupti Dabholkar
- E-Da Hospital, Taiwan Yu-Feng Wei
- Postgraduate Institute of Medical Education and Research Pushpender Gupta
- CHU Grenobile, France Bing Fabrice

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 519 Date 2007-10-8

Discussion

No. of Applicants : 44