CTICasesUnclassified B-Cell Lymphoma
Imaging findings
A 21-year-old female has CT scans showing extensive, irregularly shaped, ill-defined lung opacities of subsegmental size bilaterally. Over a one-year period, CT shows marked progression with multifocal, multi-lobar opacities, extensive mediastinal lymph node involvement, and abnormal soft tissue in the mediastinum that is difficult to separate from potential pericardial fluid or pericardial involvement. Air bronchograms and traversing pulmonary vessels are patent within the consolidations.
Key takeaways
Patent airways and traversing vessels within progressive consolidations in a young patient are highly suggestive of a lymphoproliferative disorder (e.g., lymphoma, Castleman disease, or epithelioid hemangioendothelioma). Diagnostic confirmation requires biopsy, often needing multiple approaches (e.g., EBUS and mediastinoscopy) due to atypical morphologic and immunophenotypic features that may not fit standard diagnostic criteria.
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