Lymphoma: Pulmonary manifestations

Imaging description A 16-year-old girl presented with a two-month history of night sweats, weight loss, and cough. A radiograph of the chest revealed nodules in the right lung and mediastinal widening suggestive of lymphadenopathy (Fig. 17.1a, b). CT scan of the chest (Fig. 17.1c, d) demonstrated multiple nodules of varying sizes in both lungs. Most of the nodules demonstrated air bronchograms. In addition a pleural-based nodule was noted in the right upper lobe. Multiple enlarged mediastinal and hilar lymph nodes were present. The lung nodules and the mediastinal and hilar lymph nodes demonstrated increased FDG uptake on PET/CT (Fig. 17.1e, f). A lymph node biopsy confirmed the diagnosis of Hodgkin’s lymphoma, nodular sclerosis. Importance. Pulmonary parenchymal involvement in children is slightly more common with Hodgkin’s disease (HD) than non-Hodgkin’s lymphoma (NHL). It is seen in HD in approximately 12% of patients, most at the time of diagnosis and usually associated with mediastinal or hilar lymphadenopathy. Pulmonary involvement in NHL is seen in around 10% of cases and may occur without the presence of associated lymphadenopathy. The mechanism of spread of the disease to the lungs is typically by hematogenous or lymphangitic channels and less commonly by direct or endobronchial spread. On CT imaging, different patterns of involvement can be seen. A nodular pattern is characterized by the presence of single or multiple nodules, which may have irregular borders, air bronchograms, or cavitation (Figs. 17.1 and 17.2). Subpleural nodules or masses can also occur (Fig. 17.1). Lymphoma may also produce a pattern of lobar or segmental consolidation that can be confused with pneumonia (Fig. 17.3).