대한흉부영상의학회 Weekly Chest Cases

Case No : 1444 Date 2025-06-23

Courtesy of Jinwoo Son, Na Young Kim, Hye-Jeong Lee / Severance Hospital
Age/Sex 67 / F
Chief ComplaintDyspnea, Dizziness

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Diagnosis With Brief Discussion

Diagnosis: Pulmonary Intravascular Lymphomatosis
Radiologic Findings: Fig 1. Chest PA shows diffuse GGO in the both lungs.
Fig 2-5. CT scan shows diffuse GGO and centrilobular GGO nodules in both lungs with small amount of bilateral pleural effusion. It also shows splenomegaly on covered upper abdomen.
Fig 6. PET-CT shows diffuse FDG uptake in the both lungs.
Brief Review: Intravascular lymphomatosis, also known as malignant endotheliomatosis or angiotropic large-cell lymphoma, is a rare and distinct subtype of malignant lymphoma. It is characterized by the intravascular proliferation of neoplastic lymphoid cells, predominantly of B-cell lineage. Geographic variation has been observed in the clinical presentation. Reports indicate that patients diagnosed in Western countries exhibit a predilection for central nervous system and cutaneous involvement, whereas those diagnosed in Asian countries are more likely to present with hemophagocytic syndrome, bone marrow infiltration, fever, hepatosplenomegaly, and thrombocytopenia.
The main CT finding in pulmonary intravascular lymphomatosis is diffuse ground-glass opacity. Additional manifestations may include subpleural patchy areas of consolidation and reticulonodular lesions. These imaging features are nonspecific and can be seen in patients with diverse diseases, which may cause delayed diagnosis of this rapidly progressive and diffuse vascular tumorous condition.
References: 1. Cha MJ, Lee KS, Hwang HS, Kim TJ, Kim TS, Kim BT, Ko YH, Shim YM. Pulmonary Intravascular Lymphomatosis: Clinical, CT, and PET Findings, Correlation of CT and Pathologic Results, and Survival Outcome. Radiology. 2016 Aug;280(2):602-10. doi: 10.1148/radiol.2016151706.
Keywords

No. of Applicants : 73

▶ Correct Answer : 47/73, 64.4%

- Other , Korea (South) SEOL A LEE
- Teikyo University Hospital , Japan CHIAKI SATO
- Kyoto University , Japan AKIHIKO SAKATA
- Oita University, Faculty of Medicine , Japan FUMITO OKADA
- Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
- Shiga General Hospital , Japan YUSAKU MORIBATA
- Fukuoka university , Japan KEISUKE SATO
- Inje University Haeundae Paik Hospital , Korea (South) HYUNGIN PARK
- The Catholic University of Korea Yoeuido St. Mary , Korea (South) CHAWOONG JEON
- Seoul National University Bundang Hospital , Korea (South) YOONAH DO
- , Korea (South) KANGHWI LEE
- Osaka metropolitan university Hospital , Japan TATSUSHI OURA
- University of Yamanashi , Japan KOJIRO ONOHARA
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- Other , Korea (South) DONGYOUNG JEONG
- Osaka University , Japan AKINORI HATA
- medical scanning , Japan HIROAKI ARAKAWA
- , Japan JUN YOSHIDA
- , Japan SHUNJIRO NOGUCHI
- Dokkyo Medical University , Japan HIROAKI ARAKAWA
- Toyota Kosei Hospital , Japan YUKI HAYASHI
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- Chonbuk National University Hospital , Korea (South) YONG HWAN JO
- , Japan YUMI MAEHARA
- Chonbuk National University Hospital , Korea (South) SUBIN LEE
- Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
- Chonbuk National University Hospital , Korea (South) EUNCHONG LEE
- Funabashi General Hospital , Japan MANABU AKIMOTO
- Kyoto University , Japan SHO KOYASU
- Keio University , Japan FUMIKO YAGI
- Chonbuk National University Hospital , Korea (South) YEEUN LEE
- , Italy PAOLO BALDASSARI
- CHA University, CHA Bundang Medical Center , Korea (South) HWANGSEON JU
- Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
- Chungnam National University Hospital , Korea (South) BYEONG-KWON SHIN
- Chungbuk National University Hospital , Korea (South) HUISU LEE
- , Korea (South) DAWON PARK
- Samsung Medical Center , Korea (South) SEONGUK KIM
- Secomedic Hospital , Japan FUMINORI MIYOSHI
- Kobe Children , Japan SHUHEI NORIMOTO
- the first affiliatited hospital of nanjing medical univercity , China HAI XU
- IUHW Narita Hospital , Japan ISSEI FUKUDA
- Jiangsu province hospital , China WANGJIAN ZHA
- , Japan YOSHIKI ISHII

▶ Correct Answer as Differential Diagnosis : 5/73, 6.8%

- Kyoto City Hospital , Japan YUSUKE UTSUNOMIYA
- University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
- , Japan SUZUNE TSUKAMOTO
- , Japan MATSUNO MAI
- Kantou Rousai Hospital , Japan KAORU SUMIDA

▶ Semi-Correct Answer : 14/73, 19.2%

- Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
- , Sweden MOHAMAD TLASS
- Seoul Medical Center , Korea (South) HYUK GI HONG
- , Korea (South) HEONSEOK LEE
- Affilitated Hospital of Jining Medical college , China JIANG SHENG HUA
- , Korea (South) DONG-HO BANG
- , Japan MASAMICHI IWAI
- Ajou University Hospital , Korea (South) YOU NA KIM
- University of Yamanashi , Japan HIROYUKI MORISAKA
- Narayana Multispeciality Hospital Jaipur Rajasthan , India JAINENDRA JAIN
- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
- Other , Korea (South) CHAEHUN LIM
- University of Yamanashi , Japan HIROAKI WATANABE

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1444 Date 2025-06-23

Discussion

No. of Applicants : 73