대한흉부영상의학회 Weekly Chest Cases

Case No : 1496 Date 2026-06-22

Courtesy of Kyung Hee Lee / Inha University Hospital
Age/Sex 58 / M
Chief ComplaintRUQ pain and right lower chest wall pain for weeks.

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Diagnosis With Brief Discussion

Diagnosis: Diffuse large B-cell lymphoma
Radiologic Findings: Fig 1 Contrast-enhanced chst CT shows small right axillary lymphadenopathy.
Figs 2, 3. Chest CT show band like right lower pleural and extrapleural mass and focal left lower pleural mass. Right intercostal artery was well visualized in the mass, representing the “pleural sandwich sign”. Bilateral paraaortic soft tissue lesion and left paraesophageal soft tissue mass were also noted. Pleural mass extended into right lower chest wall with internal low attenuation.
Fig 4. Abdomen CT shows small bilateral retroperitoneal paraaortic lymphadenopathy.
Figs 5, 6. 18F-FDG PET-CT scan shows intense hypermetabolism of pleural and chest wall masses.
Brief Review: Pleural effusion and mass are common manifestations of secondary lymphoma. CT findings of lymphoma are similar to those of pleural metastasis or malignant mesothelioma. Intercostal arteries Previously, pleural sandwich sign was reported. It means well visualized intercostal arteries in the conglomerated pleural and extrapleural masses on axial contrast-enhanced CT images. Metastases, malignant mesothelioma, and solitary fibrous tumors tha usually do not have extrapleural lesion at the initial presentation or quickly invase intercostal vessels when they invade the extrapleural space. Therefore, this characteristic CT sign would be helpful to differentiate pleural lymphoma from other pleural tumors.
References: Yookyung Kim, Myungjae Lee, Yon Ju Ryu, Min-Sun Cho. The pleural sandwich Sign in Two Cases of Primary Pleural Lymphoma Korean J Radiol. 2015; 16(1):213-216.
Keywords

No. of Applicants : 82

▶ Correct Answer : 48/82, 58.5%

- Kyeongpook National University Hospital , Korea (South) JOHN BAEK
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Teikyo University Hospital , Japan ISSEI FUKUDA
- ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Kyoto University Hospital , Japan YUSUKE UTSUNOMIYA
- Chonnam National University Hospital , Korea (South) HYUNJIN KIM
- , Korea (South) DONG HEE LEE
- Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
- , Korea (South) JIN YOUNG LEE
- Kyung Hee University Medical Hospital , Korea (South) INKEON YEO
- , China FANG YING GEN
- Chonbuk National University Hospital , Korea (South) YONG HWAN JO
- Inje University Pusan Paik Hospital , Korea (South) GANGWON JEONG
- university of montreal , Canada Andrei Bogdan Gorgos I
- Osaka University , Japan AKINORI HATA
- University of Yamanashi , Japan HIROYUKI MORISAKA
- The Catholic University of Korea Seoul St. Mary , Korea (South) JIHO PARK
- Nara Medical University , Japan AYA YAMADA
- University of Yamanashi , Japan HIROAKI WATANABE
- Chonbuk National University Hospital , Korea (South) JUNGHOON OH
- Otsu Red Cross Hospital , Japan JUN YOSHIDA
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) OHMIN KWON
- Chonbuk National University Hospital , Korea (South) YEEUN LEE
- Chungnam National University Hospital , Korea (South) BYEONG-KWON SHIN
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- Shiga General Hospital , Japan YUSAKU MORIBATA
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Seoul Medical Center , Korea (South) HANSEUL CHO
- , Japan TOMOHIRO KAWAJI
- Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
- Paras hospital, Panchkula , India SHALEEN RANA
- , Japan HIROKI SHIMOYAMA
- Kyoto University , Japan SHO KOYASU
- Yonsei University,Severance Hospital , Korea (South) HYEON SIK SHIN
- Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Fukuoka university , Japan KEISUKE SATO
- Ichinomiya Nishi Hospital , Japan Takao Kiguchi
- Matsunami General Hospital , Japan TARO TAKEDA
- Ehime University , Japan TOMOHISA OKADA
- Shiga University of Medical Science , Japan RYO UEMURA
- Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
- , Korea (South) JIYUN KIM
- Fukuoka Central Hospital , Japan YUKIHISA TAKAYAMA

▶ Correct Answer as Differential Diagnosis : 23/82, 28.0%

- medical scanning , Japan HIROAKI ARAKAWA
- , Japan HIROKI SAKURADA
- Kyoto University , Japan AKIHIKO SAKATA
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- Oita university , Japan AYUMI KAMEI
- Ewha Womans University Mokdong Hospital , Korea (South) DAWON JUNG
- Other , Korea (South) SEONGSU KANG
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- QATIF CENTRAL HOSPITAL , Saudi Arabia HANI M ALSALAM
- Chiba University Hospital , Japan HIROKI MIYAZAKI
- Teikyo University Hospital, Mizonokuchi , Japan TOSHIHIRO FURUTA
- Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
- Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- , Japan SHUNJIRO NOGUCHI
- University of the Ryukyus , Japan Nanae Tsuchiya
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- Kantou Rousai Hospital , Japan KAORU SUMIDA
- , Sweden MOHAMAD TLASS
- Ehime University , Japan KOTARO MATSUMOTO
- University of Yamanashi , Japan KOJIRO ONOHARA
- , Japan YUJI OHIZUMI

▶ Semi-Correct Answer : 1/82, 1.2%

- Ehime University , Japan KAI ICHIKAWA

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1496 Date 2026-06-22

Discussion

No. of Applicants : 82