Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report
Abstract Background Intravascular large B-cell lymphoma (IVLBCL) is the proliferation of neoplastic B lymphocytes in the vascular space. Since conventional computed tomography (CT) shows nonspecific findings, differentiation between IVLBCL and other lung diseases, such as diffuse interstitial lung d...
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| Format: | Article |
| Language: | English |
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BMC
2023-04-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-023-02420-9 |
| _version_ | 1797841236083605504 |
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| author | Daisuke Yamada Ryosuke Imai Masaki Matsusako Yasuyuki Kurihara |
| author_facet | Daisuke Yamada Ryosuke Imai Masaki Matsusako Yasuyuki Kurihara |
| author_sort | Daisuke Yamada |
| collection | DOAJ |
| description | Abstract Background Intravascular large B-cell lymphoma (IVLBCL) is the proliferation of neoplastic B lymphocytes in the vascular space. Since conventional computed tomography (CT) shows nonspecific findings, differentiation between IVLBCL and other lung diseases, such as diffuse interstitial lung disease, is difficult. Case presentation A 73-year-old man presented with dyspnea and hypoxemia. Laboratory findings showed an increased lactate dehydrogenase level of 1690 U/L (normal: 130–235 U/L) and soluble interleukin-2 receptor level of 1140 U/mL (normal: 157–474U/mL). Dual-energy CT iodine mapping showed a significant symmetrical decrease in iodine distribution in the upper lungs, suggesting an unusual distribution of pulmonary hypoperfusion. Therefore, IVLBCL was suspected. A random skin biopsy confirmed the diagnosis of IVLBCL. Due to the severity of the disease, lung biopsy was averted. After admission to the hospital, high-dose methotrexate was administered for central nervous system involvement, due to findings of suspected intracranial infiltration on a brain magnetic resonance imaging and elevated cell counts on lumbar puncture. Subsequently, oxygen demand improved, and rituximab along with cyclophosphamide, doxorubicin, vincristine, and prednisone was added to the patient’s regime. Eventually, oxygen administration was terminated, the patient’s general condition improved, and the patient was discharged after 47 days of hospitalization. Conclusions Since the diagnosis of IVLBCL depends on whether it is possible to suspect IVLBCL, the finding of decreased iodine perfusion demonstrated on dual-energy CT is considered important information for diagnosis. An immediate diagnosis of IVLBCL is needed to avoid rapid disease progression and introduce early treatment for a favorable prognosis. In this case, unique pulmonary hypoperfusion demonstrated by dual-energy CT promoted early diagnosis of IVLBCL. |
| first_indexed | 2024-04-09T16:27:44Z |
| format | Article |
| id | doaj.art-aede8ac501f6486fb3ecc98c5239764b |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-04-09T16:27:44Z |
| publishDate | 2023-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-aede8ac501f6486fb3ecc98c5239764b2023-04-23T11:08:02ZengBMCBMC Pulmonary Medicine1471-24662023-04-012311410.1186/s12890-023-02420-9Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case reportDaisuke Yamada0Ryosuke Imai1Masaki Matsusako2Yasuyuki Kurihara3Department of Radiology, St. Luke’s International HospitalDepartment of Pulmonary Medicine, Thoracic Center, St. Luke’s International HospitalDepartment of Radiology, St. Luke’s International HospitalDepartment of Radiology, St. Luke’s International HospitalAbstract Background Intravascular large B-cell lymphoma (IVLBCL) is the proliferation of neoplastic B lymphocytes in the vascular space. Since conventional computed tomography (CT) shows nonspecific findings, differentiation between IVLBCL and other lung diseases, such as diffuse interstitial lung disease, is difficult. Case presentation A 73-year-old man presented with dyspnea and hypoxemia. Laboratory findings showed an increased lactate dehydrogenase level of 1690 U/L (normal: 130–235 U/L) and soluble interleukin-2 receptor level of 1140 U/mL (normal: 157–474U/mL). Dual-energy CT iodine mapping showed a significant symmetrical decrease in iodine distribution in the upper lungs, suggesting an unusual distribution of pulmonary hypoperfusion. Therefore, IVLBCL was suspected. A random skin biopsy confirmed the diagnosis of IVLBCL. Due to the severity of the disease, lung biopsy was averted. After admission to the hospital, high-dose methotrexate was administered for central nervous system involvement, due to findings of suspected intracranial infiltration on a brain magnetic resonance imaging and elevated cell counts on lumbar puncture. Subsequently, oxygen demand improved, and rituximab along with cyclophosphamide, doxorubicin, vincristine, and prednisone was added to the patient’s regime. Eventually, oxygen administration was terminated, the patient’s general condition improved, and the patient was discharged after 47 days of hospitalization. Conclusions Since the diagnosis of IVLBCL depends on whether it is possible to suspect IVLBCL, the finding of decreased iodine perfusion demonstrated on dual-energy CT is considered important information for diagnosis. An immediate diagnosis of IVLBCL is needed to avoid rapid disease progression and introduce early treatment for a favorable prognosis. In this case, unique pulmonary hypoperfusion demonstrated by dual-energy CT promoted early diagnosis of IVLBCL.https://doi.org/10.1186/s12890-023-02420-9IVLBCLDual-energy CTPulmonary hypoperfusionHypoxemiaIodine mapping |
| spellingShingle | Daisuke Yamada Ryosuke Imai Masaki Matsusako Yasuyuki Kurihara Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report BMC Pulmonary Medicine IVLBCL Dual-energy CT Pulmonary hypoperfusion Hypoxemia Iodine mapping |
| title | Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report |
| title_full | Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report |
| title_fullStr | Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report |
| title_full_unstemmed | Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report |
| title_short | Intravascular large B-cell lymphoma appearance on dual-energy computed tomography: a case report |
| title_sort | intravascular large b cell lymphoma appearance on dual energy computed tomography a case report |
| topic | IVLBCL Dual-energy CT Pulmonary hypoperfusion Hypoxemia Iodine mapping |
| url | https://doi.org/10.1186/s12890-023-02420-9 |
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