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%

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

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

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

▶ 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