대한흉부영상의학회 Weekly Chest Cases

Case No : 340 Date 2004-05-01

Courtesy of Jung Im Jung, M.D. / St. Maty's Hospital, The Catholic University of Korea, Seoul, Korea
Age/Sex 25 / F
Chief ComplaintPalpable neck mass

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Lymphoma (NHL, peripheral T-cell type, medium to large size)
Radiologic Findings: Chest radiograph shows an increased opacity in right mid lung zone, protruding into the thorax from the chest wall (Fig.a).
CT scan demonstrates the broad-based pleural plaque in anterior aspect of right thorax. The lesion is homogeneously enhanced. There is minimal pleural effusion in dependent portion of R thorax (Fig. b).
Note lymphadenopathies in the both axilla (Fig. c)
Brief Review: Involvement of the pleura by lymphoma may occur in both Hodgkin (HD) (11.4-30%) and non-Hodgkin disease (NHL) (3.7-33%). Pleural lymphoma represents either a site of recurrence or an extension of the disease from mediastinal and/or pulmonary lymphoma. Pleural lymphoma presenting as the initial manifestation of the disease is extremely rare and usually NHL, especially large cell type.
On CT and MR images pleural lymphoma appears either as a solitary nodule or as multiple, broad-based pleural plaques usually associated with pleural effusion. While pleural effusion in lymphoma can be either to obstruction of lymphatic drainage by mediastinal lymphadenopathy, pleural or pulmonary infiltration or to thoracic duct obstruction, impaired lymphatic drainage appears to be the primary mechanism in HD and direct pleural infiltration is the predominant cause in NHL. Nodules represent the confluence of lymphoid tissue.

CT and MR play a role in detecting pleural involvement of lymphoma. The detection of non-contiguous additional pleural involvement changes the classification, particularly in HD and may alter the therapeutic plan.
References: 1. Bonomo L, Feragalli B, Sacco R, Merlino B, Storto ML. Malignant pleural disease. Eur J Radiol. 2000 May;34(2):98-118.
2. North LB, Libshitz HI, Lorigan JG. Thoracic lymphoma. RCNA 1990; 28 (4): 745-762
Keywords: Chest wall, Lymphproliferative disorder, Lymphoma,

No. of Applicants : 33

▶ Correct Answer : 18/33, 54.5%

- Air force education & training command Hospital, Korea Hyukwon Chang
- Annecy Hospital, France Gilles Genin
- Centre d'imagerie Jacques Callot, Nancy, France Lionel Cannard
- Dong-A University Hospital, Korea Ki-Nam Lee
- Escola Paulista de Medicina, Fleury, Sao Paulo, Brazil Gustavo Meirelles
- Eulji hospital, Korea Jeong Joo Woo
- Ewha Woman's University Hospital, Korea Yoo Kyoung Kim
- Gwangmyoung Sung-Ae Hospital, Korea Jiyong Rhee
- Hangang SacredHeart Hospital, Korea Eil Seong Lee
- Hanyang University Hospital, Seoul, Korea Yo Won Choi
- Incheon Sarang Hospital, Korea Jung Hee Kim
- Kangbuk Samsung Hospital, Korea Hyon Joo Kwag
- Mallinckrodt Institute of Radiology, USA Jin Mo Goo
- National Taiwan University Hospital, Taiwan Tan Che Kim
- Ondokuz Mayis University, Samsun, Turkey Cetin Celenk
- Royal Melbourne Hospital, Melbourne, Australia Stefan Heinze
- Shinsegae Rad Clinic Gi Beom Kim
- Social Security Hospital, Ankara, Turkey Meric Tuzun

▶ Semi-Correct Answer : 4/33, 12.1%

- CH Lyon sud, France Xavier Riviere
- CHU Nancy-Brabois, France Denis Regent
- CIM Saint Dizier, France JC Leclerc
- Homs National Hospital, Homs, Syria Rami Abou Zalaf

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 340 Date 2004-05-01

Discussion

No. of Applicants : 33