IMPORTANT: We currently have a number of bugs related to image cropping and are actively trying to resolve them. In the meantime, we have disabled cropping. Apologies for any inconvenience. Stay informed: radiopaedia.org/chat

Consolidative marginal zone lymphoma

Case contributed by Dayu Gai
Diagnosis certain

Presentation

Persistent cough, refractory to antibiotics.

Patient Data

Age: 65 years
Gender: Female

Extensive consolidation in the left mid to upper zone with moderate associated pleural effusion. Regions of lucency in the left upper zone suggestive of cavitation. Small nodule in the right mid to upper zone is non-specific. 

The findings are typical for infection, although in the context of persistent changes refractory to antibiotics, neoplasia or tuberculosis should be considered.

CT confirms the findings of consolidative change involving both lobes, with more cavitating change at the apex.

The patient proceeded to an FDG PET study.

Nuclear medicine

Moderate FDG avidity in the non-cavitating regions of left upper lobe consolidation. The right upper zone nodule is non FDG avid. Findings are still favored to represent infection, with a differential of malignancy.

The patient proceeded to bronchoscopic biopsy of the left upper lobe infiltrate. Histopathology showed an infiltrate of small atypical lymphocytes with an immunophenotype consistent with marginal zone lymphoma.

Case Discussion

A good example of non-resolving consolidation. Despite the appearances being consistent with infection, the temporal profile and persistence despite antibiotic treatment raises the possibility of lymphoma +/- other malignancy.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.