CTICasesHodgkin Lymphoma with Pulmonary Involvement Mimicking Cavitary Infection
Imaging findings
CT demonstrates a large anterior mediastinal soft tissue mass with characteristic infiltrating appearance extending into the adjacent lung, producing a consolidative opacity with cavitation and small surrounding nodules in the right lung. The appearance mimics a pulmonary infection, particularly a cavitary bacterial pneumonia with satellite nodules. The mediastinal component is clearly a large mass extending along the mediastinal border. Core biopsy of the pulmonary component confirmed Hodgkin lymphoma without any infection. The case is discussed in the context of Godwin's 1978 paper on cavitating lymphoma.
Key takeaways
Hodgkin lymphoma can produce direct pulmonary involvement via contiguous extension from mediastinal nodal disease, resulting in areas of consolidation, cavitation, and small satellite nodules that closely mimic cavitary infection including tuberculosis and bacterial abscess. The combination of a large anterior mediastinal mass with adjacent pulmonary consolidation and cavitation should raise lymphoma as a primary consideration even when the appearance suggests infection. Cavitary Hodgkin lymphoma has been described in the literature since 1978 (Godwin). Biopsy of the pulmonary component may be necessary for diagnosis.
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