Primary Pulmonary Hodgkin Lymphoma

A 32-year-old male complained of a continued cough for more than 2 months and a rapidly growing neck mass for 2 weeks.

Contrast-enhanced MDCT [images A, B, C]:

• Axial mediastinal and pulmonary windows. Coronal mediastinal window
• Multiple variable-sized scattered cavitary lung lesions with mediastinal and hilar lymphadenopathy

– Red arrow: cavitary lung lesions

– White arrow: mediastinal LNs

Follow-up contrast-enhanced MDCT [image D]; after 4 cycles of chemotherapy.

• Axial mediastinal and pulmonary windows
• Dramatic response in the form of a significant reduction in the size and extension of previously noted cavitary lung lesions and mediastinal lymphadenopathy

– Red arrow: resolved cavitary lung lesions

– White arrow: resolved mediastinal LNs

• The rarity of pulmonary Hodgkin’s lymphoma may lead to it being not considered in the differential diagnosis of a pulmonary lesion. The frequency of lymphomas arising in the lung is estimated to be less than 1% of all lymphomas.
• Differential Diagnosis include most importantly tuberculosis, multiple pyemic abscesses, Wegener’s granulomatosis, sarcoidosis & metastatic carcinomas, and needs to be differentiated from them
• Diagnostic imaging plays a critical role in the initial evaluation, monitoring, and follow-up of lymphoma patients