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Compensatory asymmetric hemidiaphragmatic uptake secondary to contralateral hemidiaphragmatic paresis

Yingbing Wang1, Mannudeep Kalra, James Scott

  • 1Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA. ywang34@partners.org

Clinical Nuclear Medicine
|December 18, 2012
PubMed

Insights

Positron emission tomography/computed tomography (PET/CT) revealed partially treated lymphoma in a patient with diffuse large B-cell lymphoma. The scan also showed left diaphragmatic paresis, likely due to phrenic nerve involvement by the mediastinal mass.

Area of Science:

  • Oncology
  • Nuclear Medicine
  • Thoracic Imaging

Background:

  • Diffuse large B-cell lymphoma (DLBCL) can present as an anterior mediastinal mass.
  • Chemotherapy is a standard treatment for DLBCL.
  • Positron emission tomography/computed tomography (PET/CT) is utilized for treatment response assessment.

Observation:

  • A 59-year-old male with DLBCL and an anterior mediastinal mass underwent PET/CT after two chemotherapy cycles.
  • PET/CT demonstrated residual FDG uptake in the left prevascular mass, indicating partial treatment response.
  • Asymmetric diaphragmatic uptake on PET suggested compensatory workload in the right hemidiaphragm due to left diaphragmatic paresis.

Findings:

  • The PET/CT findings were consistent with partially treated lymphoma.
  • Left diaphragmatic paresis was observed, likely secondary to phrenic nerve compression by the mediastinal mass.
  • Compensatory increased activity in the right hemidiaphragm was noted on PET.

Implications:

  • This case highlights the utility of PET/CT in evaluating treatment response and identifying unexpected complications like diaphragmatic dysfunction in lymphoma patients.
  • Phrenic nerve involvement by mediastinal masses can lead to significant diaphragmatic paresis.
  • Understanding these imaging findings is crucial for comprehensive patient management and prognostication in thoracic oncology.

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