Case 18 - T Cell Lymphoma, lymphadenopathy

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: CT Neck with intravenous contrast

INDICATION: 55-year-old female with history of 3 weeks of progressive swelling of face, abdomen, and lungs treated for lines disease with doxycycline and appeared to feel worse. Rash over the torso with lymphadenopathy and exudative tonsillitis.

TECHNIQUE: Axial CT imaging was obtained through the neck from the level of the frontal sinuses to the thoracic inlet with intravenous contrast and reconstructed sagittal and coronal imaging.

COMPARISON: Chest CT 7/31/2019

FINDINGS:

The visualized intracranial contents are unremarkable. Right maxillary sinus mucus retention cyst. Mild mucosal thickening of the paranasal sinuses.

The orbits are unremarkable.

The aerodigestive tract shows retropharyngeal edema noteworthy as seen best on series 7 image 245. There is bilateral enlargement of the palatine tonsils which causes narrowing of the airway on series 7 image 178. Prominent nasopharyngeal adenoidal tissue greater than expected for age is present on series 7 image 105.

Bilateral necrotic submandibular lymph nodes measure up to 1.4 cm on right and 1.3 cm on the left. The patient has intraparotid lymph nodes which are best seen on series 7 image 1:15 on the right side and series 7 image 132 on the left side. The thyroid, and submandibular glands are unremarkable.

There is multistation cervical lymphadenopathy. Multiple lymph nodes demonstrate central necrosis. For reference:

--Bilateral level IIa lymph nodes measure up to 2.2 cm on the right and 2.2 cm on the left.

--Bilateral level IIb lymph nodes measure up to 1.3 cm on right and 1.2 cm on the left.

--Bilateral level VA/necrotic nodes measure up to 0.9 cm on the right and 0.8 cm on the left.

--Bilateral level 3 lymph nodes measure up to 0.8 cm on right and 0.9 cm on the left.

Additional right prepectoral lymph node measures 1.0 cm.

Major vasculature, including bilateral common and internal carotids, as well as internal jugular veins, appear patent.

Hyoid bone, thyroid cartilage, and cricoid cartilage are normal.

Patent trachea. Emphysematous changes in the lung apices.

Multilevel degenerative changes of the cervical spine, greatest at C5-C6 with mild to moderate left neural foraminal narrowing.

IMPRESSION:

1. Multistation cervical lymphadenopathy, enlarged bilateral submandibular lymph nodes, and a mildly enlarged right retropectoral lymph node. Multiple lymph nodes demonstrate central necrosis, suspicious for necrotizing adenitis (TB, Cat scratch fever, Kikuchi), metastatic disease, and less likely lymphoma . Inflammatory changes of pharyngitis and retropharyngeal edema.