Lymphomatoid granulomatosis (pulmonary manifestations)
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- updated 4 Dec 2023:
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Pulmonary manifestations of lymphomatoid granulomatosis are important since the lung is one of the most frequent sites of involvement in lymphomatoid granulomatosis. It falls under the group of pulmonary angiitis and granulomatosis.
Pathology
Some consider the condition to be midway between overt pulmonary lymphoma and granulomatosis with polyangiitis (GPA)4,7. Microscopically, it shows polymorphous and atypical lymphoreticular infiltration of pulmonary vessel walls with a variable spectrum of necrosis.
Radiographic features
Features on imaging can be indistinguishable from those of GPA.
Plain radiograph
- multiple lung nodules/masses: typically small but can be variable in size (1-8 cm) 1
- areas of consolidative change
CT
Recognised CT features include 3:
- conglomerating small lung nodules
- usually in the peribronchovascular distribution
- nodules may cavitate
- coarse irregular opacities
- small thin-walled cysts
- mediastinal nodal enlargement 5,7
Nuclear medicine
- nodules are hypermetabolic on 18F PET-CT 7
Differential diagnosis
On a chest radiograph, possible considerations include:
-<p><strong>Pulmonary manifestations of lymphomatoid granulomatosis</strong> are important since the <a href="/articles/lung">lung</a> is one of the most frequent sites of involvement in <a href="/articles/lymphoid-granulomatosis">lymphomatoid granulomatosis</a>. It falls under the group of <a href="/articles/pulmonary-angiitis-and-granulomatosis">pulmonary angiitis and granulomatosis</a>.</p><h4>Pathology</h4><p>Some consider the condition to be midway between overt <a href="/articles/pulmonary-lymphoma">pulmonary lymphoma</a> and <a href="/articles/granulomatosis-with-polyangiitis-thoracic-manifestations-1">granulomatosis with polyangiitis (GPA)</a> <sup>4,7</sup>. Microscopically, it shows polymorphous and atypical lymphoreticular infiltration of pulmonary vessel walls with a variable spectrum of necrosis. </p><h4>Radiographic features</h4><p>Features on imaging can be indistinguishable from those of GPA. </p><h5>Plain radiograph</h5><ul>- +<p><strong>Pulmonary manifestations of lymphomatoid granulomatosis</strong> are important since the <a href="/articles/lung">lung</a> is one of the most frequent sites of involvement in <a href="/articles/lymphoid-granulomatosis">lymphomatoid granulomatosis</a>. It falls under the group of <a href="/articles/pulmonary-angiitis-and-granulomatosis">pulmonary angiitis and granulomatosis</a>.</p><h4>Pathology</h4><p>Some consider the condition to be midway between overt <a href="/articles/pulmonary-lymphoma">pulmonary lymphoma</a> and <a href="/articles/granulomatosis-with-polyangiitis-thoracic-manifestations-1">granulomatosis with polyangiitis (GPA)</a> <sup>4,7</sup>. Microscopically, it shows polymorphous and atypical lymphoreticular infiltration of pulmonary vessel walls with a variable spectrum of necrosis. </p><h4>Radiographic features</h4><p>Features on imaging can be indistinguishable from those of GPA. </p><h5>Plain radiograph</h5><ul>
-<li>areas of <a href="/articles/air-space-opacification-1">consolidative change</a>- +<li>areas of <a href="/articles/consolidation">consolidative change</a>
-<li>nodules may cavitate </li>- +<li>nodules may cavitate </li>
-</ul><h5>Nuclear medicine </h5><ul><li>nodules are hypermetabolic on 18F PET-CT <sup>7</sup>- +</ul><h5>Nuclear medicine </h5><ul><li>nodules are hypermetabolic on 18F PET-CT <sup>7</sup>
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Image 1 CT (lung window) ( create )
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