CTICasesHodgkin Lymphoma Presenting as a Masslike Right Upper Lobe Consolidation
[...]. Hodgkin Lymphoma Presenting as a Masslike Right Upper Lobe Consolidation. CTICases. Published September 19, 2026. https://cticases.com/c/h7ukk
Imaging findings
A man of about 35 with a smoking history presented with chest pain and possibly fever and was treated for community-acquired pneumonia without improvement. The frontal radiograph showed a dense but sharply marginated right upper lobe consolidation with elevation of the right hilum and upward retraction of the bronchus suggesting volume loss. CT showed a mass occupying the anterior right upper lobe and extending toward the apex with prominent air bronchograms, extensive mediastinal and some hilar lymphadenopathy, narrowing of the superior vena cava at the brachiocephalic confluence with collateral vessels, and background emphysema. Bronchoscopic biopsy showed classic Hodgkin lymphoma. On a recent follow-up scan the lymphadenopathy had resolved, leaving upper lobe bronchiectasis that resembled old tuberculosis.
Key takeaways
A masslike consolidation that fails to resolve with antibiotics needs a tissue diagnosis. Lung cancer is plausible even at 30 in a smoker, fungal infection such as blastomycosis can form large masses but rarely causes bulky adenopathy or superior vena cava narrowing, and granulomatosis with polyangiitis does not explain the nodes. Air bronchograms are a classic feature of pulmonary lymphoma because it is a soft tumor that infiltrates around airways rather than obliterating them. Hodgkin lymphoma involves the lung more often than non-Hodgkin lymphoma and can appear as nodules, intrapulmonary lymph nodes, or masslike consolidation, and airway distortion may reflect the sclerosing component of nodular sclerosing disease. Biopsy can be difficult when Reed-Sternberg cells are not sampled, and the residual bronchiectasis after treatment can later be mistaken for old tuberculosis.
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