J Korean Soc Radiol.  2012 Oct;67(4):241-244. 10.3348/jksr.2012.67.4.241.

Gradual Progression of Intrapulmonary Lymph Nodes Associated with Usual Interstitial Pneumonia in Progressive Systemic Sclerosis on Chest Radiographs and CT

• Kim SM
• Ohm JY
• Chung MH
• Kim YH

• KMID: 1439533
• DOI: http://doi.org/10.3348/jksr.2012.67.4.241

Abstract

A 40-year-old female visited the clinic for evaluation of Raynaud's phenomenon for a period of four years. The initial chest radiograph showed a fine reticular density and ground glass opacity with lower lobe predominance. These findings are consistent interstitial fibrosis. Additionally, high resolution CT showed multiple, small, coexisting nodular opacities, ranging from 3 to 7 mm in size in both lungs. These nodules grew up to 1.5 cm and showed moderate enhancement. Because of the rareness of intrapulmonary lymph node in patient of progressive systemic sclerosis, we couldn't exclude the possibility of malignancy. These nodules are turned out to be intrapulmonary lymph nodes on video-assisted thoracoscopic lung biopsy.

MeSH Terms

Adult
Biopsy
Female
Fibrosis
Glass
Humans
Idiopathic Pulmonary Fibrosis
Lung
Lymph Nodes
Scleroderma, Diffuse
Thorax

Figure

• 

  Fig. 1 A 40-year-old female with history of Raynaud's phenomenon. A. The initial chest radiograph shows diffuse fine reticular densities and ground-glass opacities in both lung fields with basal lung predominance. B. HRCT shows fine reticulonodular densities and diffuse ground-glass opacities in the right middle lobe, both lower lobes and left lingular segment. Findings are compatible with interstitial lung disease due to PSS. Nodules in the right middle lobe and left lingular segments (arrows) were overlooked at this point of time. C. Six years later, follow-up chest radiograph shows irregular reticulonodular opacities bilaterally. The lung volume was slightly decreased. D, E. Follow-up HRCT shows interval increase in size of the nodules in the right middle lobe (arrow) and left lingular segment (arrow). The nodules in the right middle lobe become lobulated. Nodules are found more than 1 cm away from the pleura. There are increased in the honeycomb cysts. F, G. Histologic examination of the nodules reveals a lymph node with lymphoid follicles in the lung parenchyma (Hematoxylin and Eosin stain, × 100). H. Lung tissue obtained by wedge resection of the right lower lobe shows interstitial pneumonia compatible with the usual interstitial pneumonia pattern, due to the moderate activity of PSS (Hematoxylin and Eosin stain, × 100). Note.-HRCT = high resolution CT, PSS = progressive systemic sclerosis

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