Related Experiment Video
Updated: May 20, 2026
Point-of-Care Lung Ultrasound in Adults: Image Acquisition
Published on: March 3, 2023
[Diagnostic difficulties caused by a pulmonary infiltrate]
Zsófia Simon1, Adám Jóna, Zsófia Miltényi
1Debreceni Egyetem, Általános Orvostudományi Kar, Orvos- és Egészségtudományi Centrum, Debrecen Nagyerdei krt. 98. 4032. zsocogo@gmail.com
Unlabelled:
Lung infiltration still causes differential diagnostic difficulties, which may delay the start of definitive treatment.
Case Report:
The examination of a 30-year-old man began due intermittent, remittent and permanent fever. Chest X-ray confirmed infiltration in the right upper lobe, which was accompanied by elevated CRP and physiological levels of procalcitonin. Most likely atypical pneumonia, tuberculosis, Wegener's granulomatosis or a malignant process was suspected. Throughout his examination infection could not be verified, repeated CT guided transthoracic needle biopsy suggested the possibility of a malignant process. Through surgical exploration the intraoperative histology was not informative; thus, the pneumonitis-remodelled right lung was removed due to the possibility of malignant transformation. Histological examination revealed lymphocyte rich classical Hodgkin lymphoma, which was found to be stage IV/B based on the 18FDG-PET/CT scan; therefore, eight cycles of ABVD (adriablastin, bleomycin, vinblastine, and dacarbazine) therapy was administered successfully. The patient is currently (for 30 months) in a complete metabolic remission.
Conclusion:
Primary pulmonary Hodgkin lymphoma is a rare disease entity (in this case it might be the original process), in which the diagnosis is often difficult. 18FDG-PET/CT may be a useful early diagnostic tool investigating fever of unknown origin.
Insights
Diagnosing primary pulmonary Hodgkin lymphoma is challenging, often delaying treatment. This case highlights 18FDG-PET/CT as a valuable tool for investigating unexplained fever and aiding early diagnosis.
Area of Science:
- Oncology
- Pulmonology
- Diagnostic Imaging
Background:
- Lung infiltrations present diagnostic challenges, potentially delaying crucial treatment initiation.
- Distinguishing between infectious, inflammatory, and malignant causes of lung lesions requires a comprehensive diagnostic approach.
Observation:
- A 30-year-old male presented with persistent fever and a right upper lobe lung infiltration on chest X-ray.
- Initial investigations, including CT-guided biopsy, were inconclusive, leading to surgical resection of the affected lung.
- Histopathological examination revealed stage IV/B classical Hodgkin lymphoma.
Findings:
- The patient was successfully treated with eight cycles of ABVD (adriablastin, bleomycin, vinblastine, and dacarbazine) therapy.
- Following treatment, the patient achieved complete metabolic remission, maintained for 30 months.
Implications:
- Primary pulmonary Hodgkin lymphoma is a rare and diagnostically difficult entity.
- 18FDG-PET/CT scans can be instrumental in the early diagnosis of fever of unknown origin and suspected pulmonary malignancies.
- Prompt diagnosis and appropriate therapy, such as ABVD, are crucial for favorable outcomes in advanced-stage Hodgkin lymphoma.
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