Which radiographic findings are characteristic of pleural involvement of non-Hodgkin lymphoma (NHL)?

Updated: Mar 05, 2019
  • Author: Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR; Chief Editor: Eugene C Lin, MD  more...
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Answer

NHL may extend into the pleural space by means of direct extension from contiguous chest-wall involvement or lung parenchymal disease. Pleural involvement in NHL (similar to that in HD) is characterized by nodular or plaquelike subpleural deposits of lymphomatous tissue or a pleural effusion due to obstruction of the lymphatics, pulmonary veins, or thoracic duct. Alternatively, it is a result of direct pleural invasion. Primary pleural lymphoma is rare and is usually associated with mediastinal or lung parenchymal disease, although disease recurrence is occasionally confined to the pleura.

Pleural effusions are seen on chest radiographs in up to 25% of patients with lymphoma at presentation; on CT scans, they are seen in an even higher percentage of patients. Individuals with large mediastinal masses are particularly prone to pleural effusions. Most pleural effusions associated with lymphomas are small, unilateral, and exudative. These generally resolve promptly with treatment. A chylothorax can be caused by lymphatic obstruction and would be slow to resolve.

Dunnick and colleagues described the radiographic manifestations of Burkitt lymphoma in 40 American patients. Pleural effusions were found to be the most common intrathoracic abnormality; they were correlated with abdominal ascites more frequently than they were with intrathoracic tumors. [23]


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