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Weekly Chest CasesArchive of Old Cases

Case No : 1456 Date 2025-09-15

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  • Courtesy of Taehee Lee, Hye Soo Cho, Woo Hyeon Lim / Seoul National University Hospital
  • Age/Sex 49 / M
  • Chief ComplaintFever, s/p left pneumonectomy for aspergillosis (30 years ago)
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Pyothorax-associated lymphoma
Radiologic Findings
Fig 1. Chest PA radiograph shows a large mass with rim calcification occupying the left hemithorax.
Fig 2-4. CT scans demonstrate a substantial mass within the left pneumonectomy cavity, featuring an enhancing soft tissue component and a protrusion into the anterior chest wall. A small lymph node is noted at the level of the left 8th/9th rib.
Fig 5. MRI reveals a strongly diffusion-restrictive lesion corresponding to the protruding mass in the anterior chest wall. The upper image represents the B1000 sequence, while the lower image shows the Apparent Diffusion Coefficient (ADC) map.
Brief Review
Pyothorax-associated lymphoma (PAL) is a rare type of non-Hodgkin's lymphoma strongly linked to long-standing chronic empyema, often resulting from artificial pneumothorax therapy for tuberculosis, which was common before 1970. The latency period between therapy and PAL onset typically exceeds 20 years, and in many cases, stretches beyond 40 years. This disease primarily affects men with a mean diagnosis age of 60
References
1. Ueda T, Andreas C, Itami J, Miyakawa K, Fujimoto H, Ito H, Roos JE. Pyothorax-associated lymphoma: imaging findings. AJR Am J Roentgenol. 2010 Jan;194(1):76-84.
Keywords

No. of Applicants : 84

▶ Correct Answer : 60/84,  71.4%
  • - Funabashi General 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
  • - , Italy PAOLO BALDASSARI
  • - , France CHARLES DAMIEN
  • - Teikyo University Hospital , Japan CHIAKI SATO
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Kyeongpook National University Hospital , Korea (South) JUNGMIN LEE
  • - , China FANG YING GEN
  • - Chonbuk National University Hospital , Korea (South) YONG HWAN JO
  • - Oita University, Faculty of Medicine , Japan FUMITO OKADA
  • - Seoul Medical Center , Korea (South) HYUK GI HONG
  • - university of montreal , Canada Andrei Bogdan Gorgos I
  • - Osaka University , Japan AKINORI HATA
  • - 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
  • - Inje University Pusan Paik Hospital , Korea (South) JIYEON HAN
  • - Yonsei University,Severance Hospital , Korea (South) JUN GU KANG
  • - Japanese Red Cross Otsu Hospital , Japan JUN YOSHIDA
  • - Oita university , Japan NORITAKA KAMEI
  • - , Japan KENTARO KOTANI
  • - Chonbuk National University Hospital , Korea (South) YEEUN LEE
  • - Other , Korea (South) CHAEHUN LIM
  • - Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
  • - , Japan SHUNJIRO NOGUCHI
  • - , Japan MARINO TANIGUCHI
  • - , Japan MASAMICHI IWAI
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Shiga General Hospital , Japan YUSAKU MORIBATA
  • - Avrasya Hospital/ISTANBUL , Turkey MURAT ULUSOY
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - , Japan HIROAKI OKADA
  • - Osaka metropolitan university Hospital , Japan TATSUSHI OURA
  • - Department of Radiology, Nara Medical University Hospital, Nara, Japan , Japan KATSUTOSHI HORIUCHI
  • - GHICL , France MANUEL TOLEDANO
  • - TB centre kasaragod. , India rikhy krishnan
  • - Korea University Anam Hospital , Korea (South) KYU-CHONG LEE
  • - Kyoto University , Japan SHO KOYASU
  • - Kobe Children , Japan SHUHEI NORIMOTO
  • - Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO
  • - Kantou Rousai Hospital , Japan KAORU SUMIDA
  • - Other , Korea (South) DONG HAN SHIN
  • - Matsunami General Hospital , Japan TARO TAKEDA
  • - Ehime University , Japan KOTARO MATSUMOTO
  • - , Japan YUMI MAEHARA
  • - Nara medical university , Japan HIROHIDE WATANABE
  • - Toyota Kosei Hospital , Japan YUKI HAYASHI
  • - Chonbuk National University Hospital , Korea (South) HYEONG RYUN CHO
  • - University of Yamanashi , Japan KOJIRO ONOHARA
  • - Jiangsu province hospital , China WANGJIAN ZHA
▶ Correct Answer as Differential Diagnosis : 10/84,  11.9%
  • - Secomedic Hospital , Japan FUMINORI MIYOSHI
  • - University of Yamanashi , Japan TAKAAKI HASHIMOTO
  • - University of Yamanashi , Japan HIROYUKI MORISAKA
  • - , Japan KANGO KUWABARA
  • - Chonbuk National University Hospital , Korea (South) SEUNG HO LEE
  • - Jichi Medical University, School of Medicine , Japan MITSURU MATSUKI
  • - Seoul National University Bundang Hospital , Korea (South) YOONAH DO
  • - Kyung Hee University Medical Hospital , Korea (South) JEONG TAEK YOON
  • - Fukuoka university , Japan KEISUKE SATO
  • - Ehime University , Japan TOMOHISA OKADA
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