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Pulmonary Angiogram
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Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
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Updated: Dec 1, 2025

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Multiple pulmonary nodules presenting a difficult diagnostic challenge.

Martina Turrin1, Mariaenrica Tinè2, Umberto Semenzato3

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Summary
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A man initially suspected of granulomatosis with polyangiitis presented with respiratory failure. Autopsy revealed diffuse Anaplastic Large Cell Lymphoma (ALCL), a rare T-cell lymphoma, highlighting diagnostic challenges.

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Area of Science:

  • Oncology
  • Hematology
  • Pathology

Background:

  • Anaplastic Large Cell Lymphoma (ALCL) is a rare non-Hodgkin lymphoma (NHL) originating from mature T cells, comprising 1-3% of NHL cases.
  • Subtypes include ALK-positive, ALK-negative, and breast implant-associated ALCL, with ALK-negative ALCL predominantly affecting older males and having a poorer prognosis.

Observation:

  • A 56-year-old male presented with subacute symptoms mimicking granulomatosis with polyangiitis, including acute respiratory failure, fever, and crusted rhinitis.
  • Initial steroid therapy provided temporary improvement, but the patient rapidly deteriorated, requiring re-admission with Acute Respiratory Distress Syndrome (ARDS).
  • Despite broad antimicrobial and antifungal treatments, the patient required endotracheal intubation and ultimately succumbed.

Findings:

  • Histological examination via autopsy confirmed diffuse Anaplastic Large Cell Lymphoma (ALCL) as the underlying diagnosis.
  • The clinical presentation mimicked autoimmune vasculitis, posing a significant diagnostic challenge.

Implications:

  • This case underscores the importance of considering rare hematological malignancies in the differential diagnosis of conditions presenting with severe respiratory failure and systemic inflammation.
  • Delayed or missed diagnosis of ALCL can lead to rapid disease progression and poor outcomes, emphasizing the need for thorough diagnostic workups.
  • Further research into early diagnostic markers and treatment strategies for ALK-negative ALCL is warranted to improve patient survival rates.