PMC6098213_01
Axial Image From Contrast-Enhanced Computed Tomography (CT). A, Homogeneously enhancing mass in the left hemipelvis (*) was consistent with an enlarged lymph node. The degree of enhancement suggested hypervascularity, a characteristic finding in Castleman disease. B, The lesion was fluorodeoxyglucose-avid on subsequent positron emission tomography-CT.
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She had a history of recurrent unicentric Castleman disease complicated by PNP (Fig. 1).
High Resolution Axial Computed Tomography Scan. A, Inspiratory phase. B, Expiratory phase. There is persistent hypoattenuation of the pulmonary parenchyma in the expiratory phase, consistent with diffuse air-trapping. The posterior membrane of the bronchi has collapsed (arrow), confirming the expiratory technique. There is mild, diffuse bronchial wall thickening (circles). These findings are consistent with bronchiolitis obliterans.
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Computed tomography (CT) showed mild, diffuse bronchial wall thickening and multiple patchy areas of air-trapping consistent with small airway disease (Fig. 2).
Axial Computed Tomography 3 Months Before Patient Admission. A, Normal-appearing airways (arrow). B, Airway at the time of diagnosis. Bronchial wall thickening developed in the interval between scans (arrowhead). C, Another axial image at diagnosis with narrow window display settings showing diffuse air-trapping with a few scattered normal areas of lung (*).
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After initiation of the above treatment regimen, the patient's respiratory symptoms began to improve (Fig. 3).
Axial Image From Contrast-Enhanced Computed Tomography. A, Hypervascular mass in the precaval region (*), consistent with an enlarged lymph node related to Castleman disease. B, This node was fluorodeoxyglucose-avid on subsequent positron emission tomography-computed tomography.
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He also had a history of unicentric Castleman disease complicated by PNP (Fig. 4).
Axial Images From Computed Tomography. A, Inspiratory phase. B, Expiratory phase. Mild, diffuse bronchial wall thickening (arrows) and patchy areas of air-trapping (*) were consistent with bronchiolitis obliterans.
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After initiation of the above treatment regimen, the patient's respiratory symptoms began to improve (Fig. 5).
Axial images from a CT scan performed at time of presentation (A) and several months later (B) demonstrate interval resolution of lingular ground glass opacity (arrow) consistent with improvement.
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October 2017 showed a relatively stable condition (FVC, 88%; FEV1, 60%; FEV1/FVC ratio, 68%). On most recent follow-up in April 2018, his chest CT showed stability of his respiratory disease (Fig. 6).