Abstract
Introduction
Thoracic lymphoma may include nodal, lung, pleural, pericardial and chest wall involvement. Imaging is often ordered for staging of disease and to assess response to therapy. Recognition of the spectrum of possible findings that may simulate other diseases can lead to earlier suspicion and diagnosis. Radiologists should be familiar with the types of thoracic involvement that may be seen with lymphoma.
Case Info
A series of patients with thoracic lymphoma demonstrated a broad range of clinical presentations and imaging findings. Case A is a patient that presented with chest pain and impending superior vena cava syndrome; imaging showed a lobulated soft tissue mass in the anterior mediastinum, consistent with an anterior mediastinal lymphoma. Case B was an example of pulmonary lymphoma, where CT showed a solitary pulmonary nodule in the left lower lobe. In case C, a patient with endobronchial lymphoma presented with a cough, while CT revealed a mass in the left mainstem bronchus. Case D was a patient with esophageal lymphoma, who presented with chest pain and dysphagia. CT demonstrated diffuse esophageal wall thickening and an intraluminal soft tissue mass within the mid to distal esophagus. Case E involved a patient experiencing dysrhythmia. CT showed a heterogeneously enhancing lobulated soft tissue mass within the right atrium and a pericardial effusion, which later proved to be cardiac lymphoma. In case F, a patient presented with shortness of breath and CT showed left-sided pleural effusion. Pleural fluid analysis later revealed pleural lymphoma. Case G was a patient that presented with an anterior chest wall palpable lump. CT chest showed a left sternal lytic lesion with a soft tissue component infiltrating the anterior chest wall. Subsequent tissue sampling revealed chest wall lymphoma.
Disc Clinical
Thoracic lymphoma most commonly involves anterior and middle mediastinal lymphadenopathy with or without hilar disease. Extranodal lymphoma occurs when proliferation of lymphoid cells infiltrates outside of the lymph nodes and is less common but can mimic other diseases on imaging, making diagnosis difficult. Pulmonary lymphoma commonly occurs in immunosuppressed patients and features nodules, infiltrates with air bronchograms, ground glass opacities, perilymphatic nodularity, and cavitation. Endobronchial lymphoma is rare and can have a polypoid mass, postobstructive hyperinflation, atelectasis, consolidation, and involve internal mammary nodes. Esophageal lymphoma has a polypoid or circumferential mass, submucosal lesions, diffuse thickening, and ulceration. Cardiac lymphoma occurs rarely as a primary cardiac tumor and is characterized by a bulky epicardial or myocardial mass, typically right atrium involvement, epicardial encasement, and occasionally tamponade. Pleural lymphoma is also rarely a primary tumor and can manifest as an effusion or have soft tissue masses. Lastly, chest wall lymphoma is rare and includes chest wall masses, breast masses, and skeletal lesions. These cases demonstrate the various locations and appearances of lymphoma in the chest and raise awareness of potential disease mimics.
Conclusion
Thoracic lymphoma can involve various structures, including the lungs, pleura, chest wall, pericardium, lymph nodes, bones, and breasts and present with diverse features on imaging. Knowledge of the manifestations of thoracic lymphoma is important for early diagnosis and treatment.