대한흉부영상의학회 Weekly Chest Cases

Case No : 1444 Date 2025-06-23

Courtesy of Jinwoo Son, Na Young Kim, Hye-Jeong Lee / Severance Hospital
Age/Sex 67 / F
Chief ComplaintDyspnea, Dizziness

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary Intravascular Lymphomatosis
Radiologic Findings: Fig 1. Chest PA shows diffuse GGO in the both lungs.
Fig 2-5. CT scan shows diffuse GGO and centrilobular GGO nodules in both lungs with small amount of bilateral pleural effusion. It also shows splenomegaly on covered upper abdomen.
Fig 6. PET-CT shows diffuse FDG uptake in the both lungs.
Brief Review: Intravascular lymphomatosis, also known as malignant endotheliomatosis or angiotropic large-cell lymphoma, is a rare and distinct subtype of malignant lymphoma. It is characterized by the intravascular proliferation of neoplastic lymphoid cells, predominantly of B-cell lineage. Geographic variation has been observed in the clinical presentation. Reports indicate that patients diagnosed in Western countries exhibit a predilection for central nervous system and cutaneous involvement, whereas those diagnosed in Asian countries are more likely to present with hemophagocytic syndrome, bone marrow infiltration, fever, hepatosplenomegaly, and thrombocytopenia.
The main CT finding in pulmonary intravascular lymphomatosis is diffuse ground-glass opacity. Additional manifestations may include subpleural patchy areas of consolidation and reticulonodular lesions. These imaging features are nonspecific and can be seen in patients with diverse diseases, which may cause delayed diagnosis of this rapidly progressive and diffuse vascular tumorous condition.
References: 1. Cha MJ, Lee KS, Hwang HS, Kim TJ, Kim TS, Kim BT, Ko YH, Shim YM. Pulmonary Intravascular Lymphomatosis: Clinical, CT, and PET Findings, Correlation of CT and Pathologic Results, and Survival Outcome. Radiology. 2016 Aug;280(2):602-10. doi: 10.1148/radiol.2016151706.
Keywords

No. of Applicants : 73

▶ Correct Answer : 47/73, 64.4%

- Funabashi General Hospital , Japan MANABU AKIMOTO
- medical scanning , Japan HIROAKI ARAKAWA
- IUHW Narita Hospital , Japan ISSEI FUKUDA
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Kyoto University , Japan AKIHIKO SAKATA
- Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
- , Italy PAOLO BALDASSARI
- Teikyo University Hospital , Japan CHIAKI SATO
- Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
- Chonbuk National University Hospital , Korea (South) YONG HWAN JO
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Keio University , Japan FUMIKO YAGI
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- , Korea (South) KANGHWI LEE
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- Osaka University , Japan AKINORI HATA
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- , Japan YOSHIKI ISHII
- Chonbuk National University Hospital , Korea (South) YEEUN LEE
- Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- , Japan SHUNJIRO NOGUCHI
- Chungnam National University Hospital , Korea (South) BYEONG-KWON SHIN
- Shiga General Hospital , Japan YUSAKU MORIBATA
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Other , Korea (South) DONGYOUNG JEONG
- , Korea (South) DAWON PARK
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Other , Korea (South) SEOL A LEE
- Chungbuk National University Hospital , Korea (South) HUISU LEE
- Kyoto University , Japan SHO KOYASU
- Kobe Children , Japan SHUHEI NORIMOTO
- Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- Chonbuk National University Hospital , Korea (South) SUBIN LEE
- Samsung Medical Center , Korea (South) SEONGUK KIM
- , Japan YUMI MAEHARA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- University of Yamanashi , Japan KOJIRO ONOHARA
- , Japan JUN YOSHIDA
- Jiangsu province hospital , China WANGJIAN ZHA

▶ Correct Answer as Differential Diagnosis : 5/73, 6.8%

- , Japan SUZUNE TSUKAMOTO
- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- , Japan MATSUNO MAI
- Kantou Rousai Hospital , Japan KAORU SUMIDA

▶ Semi-Correct Answer : 14/73, 19.2%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- , Korea (South) DONG-HO BANG
- Seoul Medical Center , Korea (South) HYUK GI HONG
- University of Yamanashi , Japan HIROYUKI MORISAKA
- University of Yamanashi , Japan HIROAKI WATANABE
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Ajou University Hospital , Korea (South) YOU NA KIM
- Other , Korea (South) CHAEHUN LIM
- , Korea (South) HEONSEOK LEE
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- , Japan MASAMICHI IWAI
- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- , Sweden MOHAMAD TLASS

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1444 Date 2025-06-23

Discussion

No. of Applicants : 73