The CT appearance of pleural and extrapleural disease in lymphoma

OBJECTIVE: Pleural effusions in patients with lymphoma that are assumed to be related to malignancy are attributed to either lymphatic obstruction by tumour with resultant decreased clearance of pleural fluid, or direct tumou r involvement of the pleura, The purpose of our study was to determine how often pleural or extrapleural disease was detected by computed tomography ( CT) of patients with pleural effusions and primary or recurrent lymphoma. METHODS AND MATERIALS: We reviewed CT examinations showing evidence of pleu ral effusion in 61 patients with a diagnosis of primary or recurrent lympho ma and no history of other systemic disorders, including infection. The stu dy population consisted of patients with non-Hodgkin's lymphoma (n = 44) or Hodgkin's disease (n = 17); both primary disease (n = 11) and recurrent di sease (IL = 50) were represented. Each CT examination was evaluated for the presence of disease involving the visceral and parietal pleura and extrapl eural space, mediastinal adenopathy, and pulmonary parenchymal disease. RESULTS: Fourteen patients (23%) (nine with non-Hodgkin's lymphoma and five with Hodgkin's disease) had parietal pleural disease (thickening or nodule s), Eighteen patients (30%) (14 with non-Hodgkin's lymphoma, four with Hodg kin's disease) had tumour or enlarged lymph nodes in the extrapleural space , Forty-three patients (70%) had mediastinal lymphadenopathy, Patients who received intravenous contrast did not have evidence of visceral pleural abn ormalities or underlying pulmonary parenchymal disease, CONCLUSION: Forty-one percent of the patients with lymphoma and pleural eff usions had CT evidence of pleural and/or extrapleural disease. The majority of the patients with extrapleural disease had adjacent posterior mediastin al disease. (C) 1999 The Royal College of Radiologists.