QUIZ: No. 4, 01/02/2026

QUIZ No. 4

Diagnosis – Secondary pulmonary lymphoma with disseminated nodal and extranodal involvement

Findings - Bulky mediastinal lymphadenopathy, involving paratracheal, prevascular and subcarinal nodal stations. Supraclavicular lymphadenopathy. Multiple bilateral pulmonary nodules, predominantly in the lower lobes. Nodules show a peribronchial and perivascular distribution, suggestive of lymphatic spread rather than hematogenous metastases. Bilateral adrenal enlargement.

Discussion

Pulmonary involvement in lymphoma is commonly seen as part of secondary pulmonary lymphoma, reflecting spread from systemic nodal disease. Unlike pulmonary metastases, which typically show a random hematogenous distribution, pulmonary lymphoma characteristically demonstrates peribronchovascular and interstitial patterns due to lymphatic infiltration.

Mediastinal and supraclavicular lymphadenopathy are frequent in systemic lymphoma and often dominate the imaging appearance. Lower lobe predominance, bilateral disease, and associated extranodal involvement such as adrenal enlargement further support the diagnosis of lymphoma.

Adrenal involvement in lymphoma is usually bilateral and bulky, in contrast to metastatic disease, where adrenal deposits are more often unilateral and nodular. Recognition of this imaging pattern is essential, as management is primarily systemic chemotherapy, and surgical intervention is not indicated.

Teaching Pearl:
Peribronchovascular pulmonary nodules with bulky mediastinal and supraclavicular lymphadenopathy and bilateral adrenal enlargement strongly favour secondary pulmonary lymphoma over metastatic lung disease.

P.S – Diagnosis confirmed by supraclavicular lymph node biopsy.