CT analysis of pulmonary lymphoma

CT analysis of pulmonary lymphoma
CT analysis of pulmonary lymphoma

Primary pulmonary lymphoma

1. Clinical overview

Primary pulmonary lymphoma is a malignant lymphoma that originates in the lymphatic tissue of the lung. It is a rare type of extranodal lymphoma, most of which originate in the lymph node tissue associated with the bronchial mucosa. Primary pulmonary lymphoma is relatively rare. The clinical symptoms lack specificity and are difficult to distinguish from other respiratory diseases. Except for a few patients with no obvious symptoms, most patients have a persistent dry cough, chest pain, dyspnea, and blood in the sputum.

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2. CT manifestations

Common CT findings: multiple consolidations in both lungs, often accompanied by air bronchial signs; other manifestations: vacuole sign, ground glass density, local consolidation of lung lobes, thickened interlobular septum, micronodules in the center of lobules, thickened tracheal wall, positive Angiographic signs: that is, enhanced pulmonary angiography, mediastinal lymphadenopathy, and pleural reactions can be seen in a uniform density of consolidation.

2 Secondary pulmonary lymphoma

1. Clinical overview

Secondary pulmonary lymphoma can invade the lung tissue by extrapulmonary lymphoma through blood dissemination, or metastasize to the lung through hilar and mediastinal lymph nodes. All lymphomas can invade the lungs, with mature B-cell lymphomas being the most common.

2. CT manifestations

Solitary or multiple nodules with a diameter of <1cm, solid masses, and thickening of the bronchial vascular bundles are similar to cancer lymphangitis, cavitation, air bronchial signs, pleural effusion, and lymphadenopathy

3. Differential diagnosis

①. Pneumonia: Bacterial pneumonia is generally absorbed to varying degrees after anti-inflammatory treatment, and most of them have corresponding clinical symptoms, such as fever and elevated white blood cells.

②. Pulmonary tuberculosis: It usually occurs in the posterior part of the apex of the upper lobe and the dorsal part of the lower lobe. It may have long burrs, calcifications, and cavities. Satellite foci are common around, and the tuberculin test is positive.

③. Lung adenocarcinoma: mostly ground glass density, the vacuole sign, surrounding fine burr, and pleural depression sign can provide a basis for the differential diagnosis.

④. Metastases: multiple nodules, more smooth edges, rare air bronchial signs, and a history of primary malignant tumors.

⑤. Wegener’s granulomatous nodules have clear edges, common cavities, thick walls, and multiple nodules located in the periphery of the lung.

4. Key reminders

①Pulmonary lymphoma can be divided into primary pulmonary lymphoma and secondary pulmonary lymphoma. The diagnosis of secondary pulmonary lymphoma is based on the patient’s history of lymphoma; the most common intrathoracic manifestation is mediastinal lymphadenopathy.

②The main CT findings of pulmonary lymphoma

  • Primary pulmonary lymphoma

Mucosal-associated lymphoid tissue lymphoma: CT findings: nodules or consolidation, multiple lungs on both sides, bronchovascular bundles, hilar or mediastinal lymph nodes enlargement.

  • Diffuse large B-cell lymphoma: CT findings: nodules or masses, cavities.

Lymphomatoid granulomatosis: CT findings: lung nodules or masses on both sides, more common at the base, near the bronchial vascular bundles, nodules fused or hollowed out, and the lesions were migratory.

  • Secondary pulmonary lymphoma: common manifestations of HD and NHL

The manifestations are diverse and non-specific; nodules/mass with or without air bronchial signs, lymphangitis, pleural effusion, and lymphadenopathy (HD>NHL).

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