Radiology Journal Reading 2

8/21/2019 Radiology Journal Reading 2

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RADIOLOGY JOURNAL READING

Wily Pandu AriawanPulmonology & Respiraory

!edi"ine


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To describe CT fndings omiscellaneous pulmonary conditions

that mimic lung cancers, especiallyprimary cancers, to improvediagnosis o pulmonary lesions

Brie descriptions o patient clinicalinormation and pathologic fndingswill be included and correlated withimaging fndings in actual cases


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The origin o the word “tomography” isrom the Greek word “tomos” meansslice or “section” and “graphe” meaning

“drawing”CT imaging system is an ! ray imagingproduces cross"sectional images or“slices” o anatomy #like the slices in a

loa or bread$ used or a variety odiagnostic and therapeutic pusposes

%& 'ood and (rug )dministration #*+-$ .hat is Computed Tomography/ 01nternet2)vailable at 3

http344wwwdagov4radiation"emittingproducts4radiationemittingproductsandprocedures4medicalimaging4medical5"rays4ucm678htm

http://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htmhttp://www.fda.gov/radiation-emittingproducts/radiationemittingproductsandprocedures/medicalimaging/medicalx-rays/ucm115318.htm


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Great improvement in CT, especiallyin high"resolution CT #:;CT$ and

ulmonary parenchymal disease3 evaluation with high"resolution CT Radiology 1989; 170:629–635

* ?wirewich C@, @edal &,


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>ulmonary conditions that mimicprimary lung cancers

The clinical conditions and theirpathologic correlations o actual cases

>ulmonary conditions grossly"lassi#ed ino $ "aegories3

Ground"glass opacifcation #GGLE bothpure and mi5ed$*&olid nodules and masses7Consolidation on :;CT


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.e will ocus on GGO and solidnodules and masses because

clinical diKculties in thediJerentiation o the benignity ormalignancy o a pulmonary lesionoccur much more reIuently in these

two types than with consolidativediseases


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GGL is defned as a haMy opacity that preservesunderlying bronchial and vascular margins on:;CT 06, 2

on neoplastic GGL is caused by partial airspace

flling, interstitial thickening with inNammation,edema, fbrosis, partial collapse o alveoli, or ocalhemorrhage 0F, 82

6 )ustin 9:,


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eoplastic GGL results mainly rom alveolarwall covering tumor growth or hemorrhagictumor 08, D2

GGL can be classifed into pure GGO and

%alo or mied GGO types according to thepresence or absence o solid components Thehalo sign represents the ground"glass opacitysurrounding the circumerence o a nodule or

mass 06, 26 )ustin 9:,


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) mi5ed GGL is a nodule that hasboth GGL and solid components


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F8"year"old woman with adenocarcinoma in situA' Pure ground(glass opa"i#"aion )diameer* +, mm- preservinginvolved pulmonary vessel in right upper lobe is shown on high"resolution CT

image.' /isolo i"all umor "ells eend al0eolar wall without destruction


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)denocarcinoma in situ #nonmucinoustype$ shows pure GGL on :;CT

(iJerential diagnosis o it includes

atypical adenomatous hyperplasia, ocalfbrosis, pulmonary hemorrhage, andacute inNammation 08, +H*2

8 >ark C


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"year"old woman with atypical adenomatous hyperplasiaA' Pure ground(glass opa"i#"aion )diameer* +1 mm- in right upper

lobe is seen on high"resolution CT image.' /isologi"ally* aypi"al "u2oidal pneumo"yes e5tend along


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Atypical adenomatous hyperplasia #)):$ is aperipheral ocal lesion produced byprolieration o atypical cuboidal or columnarepithelial cells along the alveoli andrespiratory bronchioles 07, -2

)): is a putative precursor oadenocarcinoma, including adenocarcinoma in

situ 0-27 Travis ., Brambilla O,


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1t presents as a round or oval pure GGLnodule without pleural indentation orvascular convergence

)): is usually smaller than 6 mm in

diameter, though it may be as large as +HF mm, and is indistinguishable rom nonmucinous adenocarcinoma in situ thatmaniests as pure GGL on :;CT 0+H*, 62

+ =im :P, &him Persistent pulmonary nodularground"glass opacity at thin"section CT3 histopathologic comparisonsRadiology 2007; 2#5:267–275

* akaQima ;, Pokose T, =akinuma ;, agai =, ishiwaki P, Lchiai ) ocaliMedpure ground"glass opacity on high"resolution CT3 histologic characteristics J

$o!p&t Assist To!ogr 2002; 26:323–3296 =awakami &, &one &, Takashima &, et al )typical adenomatous hyperplasia o


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F-"year"old man with ocal fbrosisA' /ig%(resoluion 34 image s%ows pure groundglass opa"i#"aion )diameer* +5

mm- in let upper lobe preserving involved bronchiole and vascular structure.' /isologi"ally* 6o"al #2rosis wi% aele"asis and infltration o inNammatory cells i


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,ocal /rosis is a %"ig" "o" "%oplasticdisease oten maniesting as a GGL thatsometimes retains the same confguration

over a long period and oten produces thesame imaging fndings as neoplastic GGL08, +, *, 2

8 >ark C


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1t presents as GGL with a round, polygonal,spiculated, or ill"defned margin on :;CT 0F2

>athologically, it appears as a ocal interstitial

septal thickening with fbroblast prolierationand preservation o alveolar airspaces andmacrophage"flled alveoli 0*, F2

* akaQima ;, Pokose T, =akinuma ;, agai =, ishiwaki P, Lchiai )ocaliMed pure ground"glass opacity on high"resolution CT3 histologiccharacteristics J $o!p&t Assist To!ogr 2002; 26:323–329

F >ark C


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*8"year"old woman with in0asi0e aspergillosis >atient had leukemia andwas treated with chemotherapy :igh"resolution CT image shows nodulewi% air 2ron"%ogram and %alo sign )diameer* +7 mm- in let upperlobe


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1n non neoplastic lesions, these patternsare mainly seen in cases with hemorrhagicnodules, such as invasive aspergillosis and

.egener granulomatosis 0D2

D >rimack &, :artman TO, ee =&, ulmonary nodules and the

CT halo sign Radiology DD-E D+367H66


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7"year"old woman with minimally invasiveadenocarcinomaA' /ig%(resoluion 34 image s%ows nodule)diameer* 8, mm- wi% air 2ron"%iologramin rig% upper lo2e' odular margin isaccompanied by Mone o ground"glass

attenuation #halo sign$.' Pa%ologi"ally* umor "ells eend widely

*8"year"old womanwith in0asi0easpergillosis


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The lesions are diKcult to distinguishrom a minimally invasive

adenocarcinoma, with a halo sign ormi5ed GGL on :;CT resulting rompredominant lepidic tumor growth

Careul attention to the patients

clinical inormation will help inmaking the correct diagnosis


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6"year"old woman with hamartomaA* 3onras(en%an"ed arge 34 image a mediasinal window showslobulated nodule #diameter, *8 mm$ with low"attenuation component in letupper lobe ow"attenuation area in nodule is not as low as that o at,resembling primary lung cancer with degeneration and necrosis

.* /isology s%ows nodule "omposed o6 "arilage* 6a* and othermesenchymal structures )rrow indicates slitlike clet lined by ciliated


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:amartoma is a benign neoplasm composed omesenchymal tissues such as cartilage, at,connective tissue, smooth muscle, andcalcifcation

>athologically, it sometimes shows slitlikeclets lined by entrapped ciliated epithelium

:amartoma accounts or H8U o solitary lung

tumors and FFU o all benign tumors 08, D2

8 Bateson O


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Typical CT fndings consist o a well"defned,smooth, round, or lobulated nodule or mass0*+2

'at is recogniMed on the CT image in about+U o cases, and popcornlike calcifcation orcentral calcifcation n about *6U 0*+2

) hamartoma with little at and no calcifcation

is diKcult to distinguish on CT rom primarylung cancer with a round or lobulated margin

*+ &iegelman &&, =houri ', &cott ..9, et al >ulmonary hamartoma3 CT

fndings Radiology D8E +377H7F


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F*"year"old woman with pneumocytomaA* 3onras(en%an"ed arge 34 image a mediasinal window ineIuivalent phase shows homogeneously enhanced solid round nodule#diameter, *6 mm$ in right middle lobe >atient underwent surgery onsuspicion o primary lung cancer

.* :pe"imen s%ows "u2oidal "ells arranged in papillary or solid patternuclear atypia is not


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>neumocytoma is a rare benign tumorpredominantly ound in middle"aged women

The emale"to"male ratio is appro5imately -H63 0*2

:istologically, the essence is prolieration otype * pneumocytes, and a pneumocytomaconsists o our maQor histologic components3solid, papillary, sclerotic, andhemangiomatous 072

7 Travis ., Brambilla O,


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Though low"attenuation areas,calcifcation, and, rarely, airmeniscussign are sometimes present on CT, most

cases usually show a smoothlymarginated, homogeneously well"enhanced, round, or oval nodule or mass,

and diJerentiation rom solid lung cancerwith round or oval margins is diKcult onCT 0**, *72** 1m 9G, =im .:, :an


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:istologic conusion with adenocarcinomawith lepidic tumor growth also occursoccasionally, with specimens obtained romnot only transbronchial lung biopsy but alsoroMen sections, especially when thespecimen contains only papillary

components 0*-2

*-


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-*"year"old woman with asymptomatic inNammatory myofbroblastic tumorA'3onras(en%an"ed 34 image s%ows round nodule )diameer* +1mm- in rig% middle lo2e'.' :urgi"al spe"imen s%ows proli6eraion o6 spindle "ells wi%mar;ed in


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Because o its variable cellular components,inNammatory myofbroblastic tumor #1


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The spindle cell components e5press vimentinand W"smooth muscle actin on immunostaining

)lthough it has a wide spectrum o benignreactive"to malignant characteristics and the

true nature o these lesions has not been ullyelucidated, the e5pression o anaplasticlymphoma inase in about 6U o casessuggests that they may be neoplastic 0*6, *2

1erkins &, Olenitoba"9ohnson =&, >erlman O, GriKn C) )= and

p8+ e5pression and chromosomal rearrangements involving *p*7 in inNammatorymyofbroblastic tumor -od 'athol 2001; 1#:569–576

* CoKn C


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Ondobronchial or endotracheal lesionsoccur occasionally, and it can occur in allother organs Though it occurs at all

ages, it reIuently is ound in childrenand adults younger than -+ years 072


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The tumor usually maniests as awell"defned lobulated or roundsolitary peripheral pulmonary noduleor mass on CT 0*82

1t occasionally shows consolidationor a nodule with an ill"defned margin

or spiculations mimicking lungcancer 0*82*8 )grons G), ;osado"de"Christenson


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The internal structure is homogeneous orheterogeneous with hemorrhage,necrosis, and calcifcation, and showsvarying degrees o contrastenhancement 0*D2

The varied CT maniestations make it

diKcult to make a correct imagingdiagnosis

*D =im T&, :an 9, =im GP, ee =&, =im :, =im 9 >ulmonary inNammatorypseudotumor #inNammatory myofbroblastic tumor$3 CT eatures withpathologic correlation J $o!p&t Assist To!ogr *++6E *D377H7D


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D"year"old woman with intrapulmonary lymph nodeA' 34 image s%ows well(demar"aed o0al nodule #diameter, F mm$ inright lower lobe


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1ntrapulmonary lymph nodes are commonly ound inthe pulmonary hilum, but they can also occur withinthe lung parenchyma, most commonly in thesubpleural Mone o the lower lobes 07+, 72

They are oten ound in smokers )s CT has improved and more CT e5aminations have

been perormed, incidental intrapulmonary lymphnodes have been ound more oten

They are usually a single nodule smaller than + mm

in diameter, with +U o cases having two or morelesions 07+2

7+ BankoJ


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>athologically, they are normal lymphnodes with a capsule and lymphoid ollicles07+, 7*2

Though they commonly present as well"defned oval nodules #'ig D$, sometimesthey show spiculations, pleural indentation,uMMy margin, and vascular involvement,mimicking primary lung cancer 07*2

7+ BankoJ


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Though they usually remain thesame siMe or many years, a ewcases grow rapidly and are diKcultto diJerentiate rom cancer 0772

77 agahiro 1, )ndou ), )oe


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"year"old woman with pulmonary tumorletsA and .* Polygonal nodule )diameer* 8= mm- )arrow, A) in right lower lobeand multiple tiny nodules (diameter, 1–3 mm) (arrowheads, A and B) in rightmiddle and lower lobe are shown on high"resolution CT images @ideo"assistedthoracic surgery was perormed or histologic e5amination3* Polygonal nodule re0ealed nonu2er"ulous my"o2a"eriosis granuloma)no s%own-' !uliple iny nodules were "omposed o6 polygonal or spindle

"ells wi% #2rous stroma Tumor cells were positive or $56) chro!ogra"i") a"d%pith%lial !%!ra"% a"tig%" "ot sho4"* Gra"&l%s o( t&!or c%lls 4%r% positi% o"


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>ulmonary tumorlets reer to a minute nodularprolieration o airway neuroendocrine cells#=ulchitsky cells$ that e5tends beyond theepithelium into the adQacent wall or lung

parenchyma 07, 7-2:istologically, a tumorlet consists o nests ooval to spindle"shaped cells

euroendocrine granules are seen on electronmicroscopy, and polypeptides similar to those

in carcinoid are present in the tumorlet7 Travis ., Brambilla O, ( >ulmonary neoplasms 1n3 'raser;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o(


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1t has a benign nonneoplastic nature 1t is oten associated with damaged and

ectatic small airways or carcinoid tumor itsel

and ranges in siMe rom microscopic to 6H8mm in diameter

) nodule bigger than this siMe should beconsidered a carcinoid

Because o their minute siMe, they are notusually apparent on CT but are oundincidentally at histopathologic e5amination,reIuently as multiple tiny lesions


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1 visualiMed on :;CT, they showwell"defned tiny nodules and arediKcult to diJerentiate rom cancer,especially rom metastatic cancer inthe case o multiple lesions 0762

76 Ginsberg


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F7"year"old man with asymptomatic tuberculomaA' /ig%(resoluion 34 image a pulmonary window s%ows nodule )diameer*+> mm- in le6 upper lo2e' Nodule %as many #ne spi"ulaions mimi";ingprimary lung "an"er' &urrounding parenchyma is emphysematous.' !ediasinal window image s%ows %eerogeneous low(aenuaion areainside nodule in "onras wi% en%an"ed margin' Paien underwen 0ideo(assised thoracoscopic surgery on suspicion o primary lung cancer

3* Pa%ologi" eaminaion s%ows epi%elioid granuloma wi% "aseousne"rosis' Diagnosis was u2er"uloma


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>ulmonary tuberculosis may present as anasymptomatic solitary pulmonary nodulecalled a tuberculoma, and histoplasmosis

may present as a histoplasmoma inimmunocompetent patients 072

They sometimes mimic lung cancer) tuberculoma is a well"defned round or

oval ocus o parenchymal tuberculosis 072

7 'raser ;&, are >( >ulmonary inection 1n3 'raser;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o(

dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A: &aunders, DDD3D6H+


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&ometimes calcifcation and cavitation in thenodule or satellite nodules can be seen andhelp in the imaging diagnosis 07, 7F2

>athologically, the central region o thetuberculoma consists o caseous necrosisand a marginal Mone o epithelioidgranuloma, inNammatory cells, and collagen

7 'raser ;&, are >( >ulmonary inection 1n3 'raser;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o(dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A: &aunders, DDD3D6H+

7F ee =&, 1m 9G CT in adults with tuberculosis o the chest3 characteristicfndings and role in management AJR 1995; 16#:1361–1367


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Tuberculomas show a variable contrast"enhancement pattern, depending on theinNammatory process on contrast"enhanced

CT, though most o them show a central low"attenuation area surrounded by ringenhancement, reNecting central necrosis andgranulomatous inNammatory tissue in the

outer Mone 078, 7D278


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This CT enhancement pattern is also ound inlung cancer with necrosis

Tuberculomas most commonly appear assmoothly marginated round nodules on CT 07,

7F2:owever, tuberculomas sometimes havespiculated margins, especially when thebackground parenchyma is emphysematous orfbrotic, making them diKcult to distinguish rom

cancer with fne spiculations 0-, 72 #'ig $


7F ee =&, 1m 9G CT in adults with tuberculosis o the chest3 characteristicfndings and role in management AJR 1995; 16#:1361–1367


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/isoplasmoma is a chronic orm o pulmonaryhistoplasmosis caused by the ungusistoplas!a caps&lat&! that !ay or !ay "ot be

associated with a history o symptomatic disease 072 1t usually is seen as a sharply defned nodule 1t may have a central Mone o calcifcation, may be

diJusely calcifed, or may be accompanied by smallsatellite nodules that resemble a tuberculoma 07,-+2


-+ :ansell (


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The presence o central or diJuse calcifcation ina nodule 7 cm or smaller in diameter is virtuallydiagnostic o a granuloma 072

1n an area where histoplasmosis is endemic, *caps&lat&! is th% !ost li%ly ca&s%; ho4%%r) inthe absence o calcifcation, the diJerentialdiagnosis must include all other causes osolitary or multiple nodules, including primarylung cancer 07, -+, -2

Lccasionally, a histoplasmoma shows shaggy orirregular edge mimicking lung cancer 0-+2

7 'raser ;&, are >( >ulmonary inection 1n3 'raser ;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o( dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A:&aunders, DDD3D6H+

-+ :ansell (


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F-"year"old man with asymptomatic rounded atelectasisA' 34 image s%ows pleural(2ased solid mass wi% spi"ulaions)diameer* $+ mm- in le6 lower lo2e mimi";ing lung "an"er'.' 3oniguous image s%ows pulmonary 0essels and 2ron"%i "ur0ingino mass )"ome(ail sign- %a %elp o ma;e "orre" diagnosis'3' 3onras(en%an"ed 34 image s%ows %omogeneous en%an"emen'!ass widely "ona"s wi% %i";ened pleura wi% "al"i#"aion'


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;ounded atelectasis is a ocal pleural based lesionthat is the result o pleural and subpleural scarringand atelectasis o the adQacent lung tissue 0-*2

1t occurs most oten in the dorsal subpleural

regions o the lower lobe in patients with a historyo asbestos e5posure and in patients withtuberculosis 0-*2

>athologic e5aminations show pleural fbrosis

overlying the abnormal parenchyma, as well asinvaginations o fbrotic pleura into the collapsedparenchyma

-* :illerdal G ;ounded atelectasis3 clinical e5perience with F- patients

$h%st 1989; 95:836–8#1


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Characteristic CT fndings consist o around mass at the lung base adQacent tothe pleural thickening and a comet"tailsignXthat is, vessels and bronchiconverge on and swirl around the mass

1t may appear as an air bronchogram 0-72 1t sometimes shows a mass with a wedge"

shaped or irregular margin on CT that isconused with a malignant tumor-7 &chneider :9, 'elson B, GonMaleM ;ounded atelectasis AJR 1980;13#:225–232


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Correct diagnosis is very important, especiallyin patients e5posed to asbestos owing to theincreased incidence o malignantmesothelioma and lung cancer

Good homogeneous enhancement on contrast"enhanced CT is a clue or diJerentiating itrom malignancy 0--2

'luorine"8"'(G >OT can also help in correctdiagnosis because the atelectasis ound ismost commonly metabolically inactive 0-62

-- :akomYki 9, =eski"isula , >aakkala T Contrast enhancement o round atelectases Acta Radiol *++*E -737FH7FD

-6 , Orasums 99, >atM O', Goodman >C, Coleman ;O Ovaluation o patientswith round atelectasis using *"08'2"Nuoro"*"deo5y"("glucose >OT J $o!p&t Assist


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D"year"old man with asymptomatic pulmonary amyloidosisA' 4%in(se"ion 34 image a pulmonary window s%ows nodule wi%serraed margin )diameer* 8$ mm- in rig% middle lo2e mimi";ingprimary lung "an"er'.' Nodule s%ows relai0ely poor en%an"emen on "onras(en%an"ed

34 image'


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)myloidosis is the accumulation o variousabnormal insoluble fbrillar proteins #amyloid$in the e5tracellular space

The most reIuent amyloid ound in the lungis amyloid light chain 0-2

)myloidosis can aJect the lung as either aprimary or secondary type, and as a systemic

type or as a disease limited to the lung

- Chen =T )myloidosis presenting in the respiratory tract 'athol A""&1989; 2#:253–273


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)myloidosis that maniests primarily in thelower respiratory tract can be di0ided ino%ree ypes3 ra"%eo2ron"%ial, nodularparen"%ymal, and di?use paren"%ymal#also termed al%olar s%ptal$ amyloidosis

odular parenchymal amyloidosis presents asa single or multiple peripheral pulmonarynodules in a wide variety o siMes with a round,lobulated, serrated, or spiculated margin 0-F2

Cavitation is seen in up to *+U o cases andcalcifcation is seen in *+H6+U on CT scans0-F2

-F >ickord :), &wensen &9, %tM 9> Thoracic crosssectional imaging oamyloidosis AJR 1997; 8376H766


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1t may grow very slowly over years>oor enhancement on contrast"enhanced CT is

reported in cases o pulmonary amyloidosis 0-82%sually,patients with nodular amyloidosis are

asymptomatic(iJerentiation rom lung cancer on CT is diKcult,

especially in cases with an uncalcifed solitarynodule with an irregular margin 0-F, -82 #'ig 7$

-F >ickord :), &wensen &9, %tM 9> Thoracic crosssectional imaging oamyloidosis AJR 1997; 8376H766

-8


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ow signal intensity on T*"weighted


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+"year"old man with lung abscess due to aspiration o oreign bodyA' /ig%(resoluion 34 image s%ows nodule )diameer* 87 mm- wi%#ne spi"ulaions and pleural indenaion in perip%ery o6 rig% lowerlo2e'.' !ediasinal window image s%ows small "a0iy in "ener o6 nodule'3' :pe"imen image s%ows paren"%ymal de6e" surrounded 2ymar;ed in#lraion o6 "%roni" in


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ung abscess is oten associated with bacterialpneumonia or is preceded by aspiration

The organisms are oten anaerobic bacteria,including ( >ulmonary inection 1n3 'raser ;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o( dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A:

&aunders, DDD3D6H+-D (ail (: Bronchial and transbronchial diseases 1n3 (ail (:, :ammar &>, eds '&l!o"ary


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They may be isolated or occur within areaso consolidation 07, -+2

1n most cases, the walls o the cavities aresmooth and less than 6 mm thick 07, 6+2

)n irregular and thick wall #Z 6 mm$ isoccasionally seen and, in such cases, itresembles cavitated lung cancer 06+2

ung abscess may also maniest as anonspecifc consolidation or nodular opacity,

and diJerentiation rom cancer ischallenging in the latter case 0-2 #'ig -$

7 'raser ;&, are >( >ulmonary inection 1n3 'raser ;&, are >(, eds ,ras%r a"d 'ar%s diag"osis o( dis%as%s o( th% ch%st) #th %d* 'hilad%lphia) 'A:&aunders, DDD3D6H+

-+ :ansell (


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+"year"old man with asymptomatic ocal organiMing pneumoniaA' /ig%(resoluion 34 image s%ows solid nodule #diameter, *6 mm$ with serratedmargin and rough spiculations in periphery o right lower lobe Convergence operipheral vessels and pleural indentation are also shown :e underwent videoassistedthoracoscopic surgery on suspicion o primary lung cancer

.' /isology image re0eals #2roi" 6o"i wi% #2ro2las prolieration, chronicinNammatory infltrate, and dilated regenerative alveolar spaces containing fbrinous


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'ocal organiMing pneumonia is reerred to asunresolving pneumonia or pneumonia with a delayedresolution, but there is no clear clinical defnition 062

1t consists histologically o polypoid granulation tissuein the alveolar spaces and peripheral bronchial lumen

associated with chronic inNammatory infltrate 062 1t shows a wide variety o CT fndings%sually, it shows consolidation Ln the other hand,

ocal organiMing pneumonia may present as a nodulewith an oval or spindle"shaped margin and satellite

lesions

6 Cordier 9' Lrganising pneumonia Thora 2000; 66378H7*8


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&ometimes the CT images o ocal organiMingpneumonia show a nodule with a spiculatedmargin, air bronchogram, bubblelike lucency, halosign, mi5ed GGL, and pleural indentationresembling primary lung cancer 06*, 672

(iJerentiation rom lung cancer is diKcult, andmany patients undergo surgery in such cases 06*,672

ot only in ocal organiMing pneumonia but also in

other inNammatory nodules as well, the marginsare sometimes concave with a ew roughspiculations 0-2

6* Pang >&, ee =&, :an 9, =im O), =im T&, Choo 1. 'ocal organiMingpneumonia3 CT and pathologic fndings J


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Lne report postulated that retraction o theaJected lobule, in contrast to intact adQacentlobules, causes a concave margin in thehealing process o the inNammation 06-2

1t sometimes mimics primary lung cancerwith spiculated margin 0-2 The diJerentiation between such

inNammatory nodules and lung cancer is

diKcult 0-, 6*, 672- 'uruya =,


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F7"year"old woman with secondary lymphoma who had been treated or non":odgkin ollicular lymphomaA' 34 image s%ows solid mass )diameer* $8 mm- wi% lobulatedmargin and ground"glass opacifcation component along bronchovascularbundle that resembles primary lung cancer

.' :pe"imen image o2ained 2y rans2ron"%ial lung biopsy shows


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>rimary lymphoma o the lung is rareress, *++-3DH*-

66 .isleM


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&econdary pulmonary lymphoma occurs morereIuently than primary lymphoma

) wide variety o CT fndings are ound inprimary and secondary lymphoma3 single or

multiple pulmonary nodules and masses,consolidation, GGL, air bronchogram, cavities,and peribronchovascular thickening 066, 62

&ometimes lymphoma maniests as a noduleor mass resembling a primary or metastatic

lung cancer in the CT images 066H6F2

66 .isleM


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) wide variety o pulmonary conditionspresent imaging eatures that mimicthose o primary lung cancers and are

diKcult to diJerentiate rom cancer)wareness o these conditions with an

understanding o their pathologic

background and careul attention tothe clinical inormation will helpachieve correct diagnoses

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