대한흉부영상의학회 Weekly Chest Cases

Case No : 1195 Date 2020-09-15

Courtesy of Yoon Ki Cha, Jeung Sook Kim / Dongguk University Ilsan Hospital , Gyeonggi-do, Korea
Age/Sex 42 / F
Chief ComplaintAbnormality in screening chest X-ray

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary epitheloid hemangioendothelioma
Radiologic Findings: Chest radiograph shows multiple small nodules in both lungs (Figure. 1). Mediastinal and lung setting of contrast-enhanced chest CT images shows multiple small variable sized poorly enhancing nodules in both lungs (Figure. 2-5). After surgical biopsy, pulmonary epitheloid hemangioendothelioma was confirmed.
Brief Review: Pulmonary epitheloid hemangioendothelioma reveals single or multiple nodules replacing normal lung architecture. These nodules display different stages of development; some show areas of calcification and ossification, while others show a characteristic chondromyxoid background, and still others may show a predominant solid cellular proliferation.
Symptoms and signs
Pulmonary epitheloid hemangioendothelioma is diagnosed incidentally in about half of the patients. Respiratory symptoms including cough, dyspnea, hemoptysis, and chest pain has been described.
The most common CT finding of pulmonary epitheloid hemangioendothelioma is the presence of multiple discrete nodules. The nodules range in size up to 2cm but most are less than 1cm in diameter. On serial CT examinations, these lesions have little or no growth. Other findings include multiple reticulonodular opacities mimicking hematolymphangitic metastasis and diffuse infiltrative pleural thickening mimicking malignant pleural mesothelioma or diffuse pleural carcinomatosis.
Surgery can be proposed in cases of unilateral single or multiple nodules. There is no single effective treatment in cases of bilateral multiple nodules. The 5-year survival probability is 60%.
Please refer to
References: KS Lee, J Han, Chung MP, YJ Jeong. Radiology Illustrated Chest Radiology 2014 Springer p.190
Keywords: lung, lung nodule, Epithelioid hemangioendothelioma,

No. of Applicants : 63

▶ Correct Answer : 22/63, 34.9%

- Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
- Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
- Mayo Clinic , United States AKITOSHI INOUE
- CH de la Cote Basque , France PAUL ARDILOUZE
- Tiger Gate Hospital , Japan SHIN-ICHI CHO
- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- , Korea (South) JIN YOUNG LEE
- Hamamatsu University Hospital , Japan HAYATO NOZAWA
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Gifu University Hospital , Japan Yo Kaneko
- Diskapi Yildirim Beyazit Hospital, Ankara , Turkey MERIC TUZUN
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Toranomon Hospital , Japan KAORU SUMIDA
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- National Center for Global Health and Medicine , Japan HIROSHI TAKUMIDA
- , Japan KAZUMA TERAUCHI
- Private sector , Greece VASILIOS TZILAS
- , Japan YUMI MAEHARA
- Hamamatsu University Hospital , Japan YUKI HAYASHI
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 6/63, 9.5%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- NIMS, HYDERABAD , India BHASKAR K
- Chungbuk National University Hospital , Korea (South) MIHYEON PARK
- Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
- , Japan HIROAKI ARAKAWA
- Nishida Hospital , Japan SHOJI OKUDA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1195 Date 2020-09-15

Discussion

No. of Applicants : 63