Lymphomatoid granulomatosis: CT and FDG-PET findings

Korean J Radiol. Nov-Dec 2011;12(6):671-8. doi: 10.3348/kjr.2011.12.6.671. Epub 2011 Sep 27.

Abstract

Objective: Lymphomatoid granulomatosis (LG) is a rare, aggressive extranodal Epstein-Barr virus (EBV)-positive B-cell lymphoproliferative disease. The purpose of our study was to analyze the CT and fluorodeoxyglucose positron emission tomography (FDG-PET) findings of pulmonary LG.

Materials and methods: Between 2000 and 2009, four patients with pathologically proven pulmonary LG and chest CT were identified. Two of these patients also had FDG-PET. Imaging features of LG on CT and PET were reviewed.

Results: Pulmonary nodules or masses with peribronchovascular, subpleural, and lower lung zonal preponderance were present in all patients. Central low attenuation (4 of 4 patients), ground-glass halo (3 of 4 patients), and peripheral enhancement (4 of 4 patients) were observed in these nodules and masses. An air-bronchogram and cavitation were seen in three of four patients. FDG-PET scans demonstrated avid FDG uptake in the pulmonary nodules and masses.

Conclusion: Pulmonary LG presents with nodules and masses with a lymphatic distribution, as would be expected for a lymphoproliferative disease. However, central low attenuation, ground-glass halo and peripheral enhancement of the nodules/masses are likely related to the angioinvasive nature of this disease. Peripheral enhancement and ground-glass halo, in particular, are valuable characteristic not previously reported that can help radiologists suggest the diagnosis of pulmonary LG.

Keywords: Air-bronchogram sign; Cavitation; Halo sign; Lymphomatoid granulomatosis; Pulmonary masses; Pulmonary nodules.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Biopsy, Needle
  • Fluorodeoxyglucose F18*
  • Humans
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Lymphomatoid Granulomatosis / diagnostic imaging*
  • Lymphomatoid Granulomatosis / pathology
  • Male
  • Middle Aged
  • Positron-Emission Tomography*
  • Radiopharmaceuticals*
  • Tomography, X-Ray Computed*

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18