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Weekly Chest CasesArchive of Old Cases

Case No : 1462 Date 2025-10-27

  • Courtesy of Sunjin Ryu, Junghoon Kim / Bundang Seoul National University Hospital
  • Age/Sex 23 / F
  • Chief ComplaintIncidentally found abnormality
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
Intrapulmonary castleman disease
Radiologic Findings
(A) Chest posteroanterior (PA) radiograph demonstrates a left paramediastinal mass. (B) Axial non-enhanced chest computed tomography (CT) image reveals a hyperenhancing mass in the superior segment of the left lower lobe (LLL) and enlarged left interlobar lymph node. (C) Axial contrast-enhanced CT image shows prominent enhancement of the mass and lymph node. (D) Coronal CT image depicts the mass with a small left pleural effusion.
Brief Review
Castleman disease (CD) is a rare lymphoproliferative disorder classified into unicentric (UCD) and multicentric (MCD) forms. UCD typically presents in the 4th decade as a solitary, enlarging mass, often discovered incidentally or due to compression symptoms, while MCD manifests in older patients with systemic symptoms like fever and weight loss. The two primary histopathologic subtypes are hyaline vascular and plasma cell variants. The hyaline vascular type is characterized by vascular proliferation, hyalinized walls, and unique lymph node architecture, including "onion skinning" and the "lollipop appearance." UCD is most commonly located in the thorax, particularly in the mediastinum or hilar region, but it may uncommonly arise in locations such as the lung, pleura, or pericardium.

Radiologically, UCD masses appear as hypervascular, round lesions, with noncontrast CT showing homogeneous hypo- or isoattenuation relative to muscle. After contrast administration, smaller thoracic lesions (<5 cm) exhibit homogeneous enhancement, while larger or extrathoracic lesions show heterogeneous patterns due to fibrosis or necrosis. Uncommon cases in the lung, pleura, or pericardium demonstrate imaging findings similar to those of UCD arising in lymph nodes. Rare calcifications (10%) may appear nonspecific. Prominent feeding vessels, a relatively specific feature, are often identified and assist in surgical planning. UCD lesions are typically larger than those in MCD, with a mean size of 5.5 cm.
References
1. Radiographics. 2023 Aug;43(8):e220210.
2. Ann Thorac Cardiovasc Surg. 2014;20
Keywords

No. of Applicants : 71

▶ Correct Answer : 26/71,  36.6%
  • - The University of Tokyo Hospital , Japan ISSEI FUKUDA
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Oita university , Japan AYUMI KAMEI
  • - , France CHARLES DAMIEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
  • - Kyung Hee University Medical Hospital , Korea (South) DONGIL KIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Aichi Medical University , Japan HIROAKI OKADA
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Fukuoka university , Japan KEISUKE SATO
  • - The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
▶ Correct Answer as Differential Diagnosis : 16/71,  22.5%
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Chonnam National University Hospital , Korea (South) JUNYEOL YANG
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - , Japan KEISUKE OSHIMA
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Ehime University , Japan KOTARO MATSUMOTO
  • - , Japan HITOSHI TAKEUCHI
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - University of Yamanashi , Japan KOJIRO ONOHARA
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