Imaging Sciences Interesting Cases
Case 273
Gurpreet Dhillon, MD
Clinical Presentation: Patient is a 37-year-old female, with history of heroin abuse and lymphoma, presenting with hemoptysis (coughing up blood clots).
Imaging Findings: A calcified mass is seen within the right middle lobe extending into the right upper lobe.
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Figure 1: AP view of the chest shows a calcified mass within the right middle lobe extending into the right upper lobe. |
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| Figure 2: Lateral view of the chest. |
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| Figure 3: Axial CT image through the base of the lungs. |
Diagnosis: Treated lymphoma
Discussion: Calcified lymph nodes in the mediastinum can have a variety of etiologies. They can be seen with infection such as tuberculosis, histoplasmosis, or coccidioidomycosis; pneumoconioses such as silicosis or coal worker's pneumoconiosis; inflammatory diseases such as sarcoidosis; and cases of treated lymphoma. Differentiation can often be made with appropriate clinical history, physical exam, and laboratory findings.
This case demonstrates diffuse, dense calcifications in the anterior mediastinum in a patient with history of lymphoma. Treated lymphoma can have egg shell type or irregular calcifications or diffuse calcifications. The calcified lymph nodes can be larger than typically seen with granulomatous disease. Calcification of lymph nodes in patients with untreated lymphoma are very rare.
References:
- Brereton HD, Johnson RE. Calcification in mediastinal lymph nodes after radiation therapy of Hodgkin's disease. Radiology. 1974 Sep;112(3):705-7. PMID: 4843306 [PubMed]
- Mergo PJ. Imaging of the Chest: A Teaching File. Lippincott Williams & Wilkins, 2002: 228.
- Panicek DM, Harty MP, Scicutella CJ, Carsky EW. Calcification in untreated mediastinal lymphoma. Radiology. 1988 Mar;166(3):735-6. PMID: 3340771 [PubMed]