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Weekly Chest CasesArchive of Old Cases

Case No : 1424 Date 2025-02-03

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  • Courtesy of Hyungin Park / Inje University Haeundae Paik Hospital
  • Age/Sex 75 / M
  • Chief ComplaintGeneral weakness
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5
  • Figure 6
  • Figure 7

Diagnosis With Brief Discussion

Diagnosis
Pyothorax-associated lymphoma
Radiologic Findings
Fig 1. Chest PA shows right CPA blunting, pleural thickening with calcification in the right mid thorax
Fig 2-5. CT scans reveals locuated right lower pleural fluid collection with diffuse pleural thickening and calcification, with adjacent passive lung atelectasis. Huge infiltrative enhancing mass is located inferiorly to a chronic empyema cavity, with hepatic extension
Fig 6-7. Axial and coronal FDG PET/CT images show intense FDG uptake along the periphery of the mass.
Brief Review
Pyothorax-associated lymphoma is a rare but important complication of chronic empyemas, with a poor prognosis. It is most commonly reported in Asia, especially Japan. Patients most commonly present with chest or back pain and/or swelling due to PAL involvement.
References
1. Hu JY, Lee KH, Yun G. Case 322: Pyothorax-associated Lymphoma. Radiology. 2024 Feb;310(2):e223090. doi: 10.1148/radiol.223090. PMID: 38411510.
2. Lee HY, Goo JM, Lee HJ et al. The value of computed tomography for predicting empyema-associated malignancy. JCAT 2006;30:453-459
3. Ueda T, Andreas C, Itami J et al. Pyothorax-Associated Lymphoma:Imaging Findings. AJR 2010;194:76-84
Keywords

No. of Applicants : 68

▶ Correct Answer : 55/68,  80.9%
  • - Ishikawa Matto Central Hospital , Japan MANABU AKIMOTO
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan SUZUNE TSUKAMOTO
  • - medical scanning , Japan HIROAKI ARAKAWA
  • - IUHW Narita Hospital , Japan ISSEI FUKUDA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Shiga University of Medical Science , Japan AKITOSHI INOUE
  • - Kyoto University , Japan AKIHIKO SAKATA
  • - McGill University Health Center , Canada ALEXANDRE SEMIONOV
  • - Oita university , Japan AYUMI KAMEI
  • - Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
  • - Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - , China FANG YING GEN
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - Osaka University , Japan AKINORI HATA
  • - Kaneda hospital , Japan HIROFUMI MIFUNE
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - , Japan YOSHIKI ISHII
  • - University of Yamanashi , Japan HIROAKI WATANABE
  • - Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Myanmar MAW MAW OO
  • - , Japan SHUNJIRO NOGUCHI
  • - , Japan MARINO TANIGUCHI
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Mie university , Japan SHIKO OKABE
  • - GHICL , France MANUEL TOLEDANO
  • - Dokkyo Medical University , Japan HIROAKI ARAKAWA
  • - Other , Korea (South) SEOL A LEE
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Paras hospital, Panchkula , India SHALEEN RANA
  • - Kyoto University , Japan SHO KOYASU
  • - , Japan SHUHEI NORIMOTO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - , Korea (South) NAEUN OH
  • - , Japan YUMI MAEHARA
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - 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 : 4/68,  5.9%
  • - , Korea (South) DONG-HO BANG
  • - , Korea (South) JIN YOUNG LEE
  • - Ajou University Hospital , Korea (South) YOU NA KIM
  • - Fukuoka university , Japan KEISUKE SATO
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