Presentation
Persistent cough, refractory to antibiotics.
Patient Data
Extensive consolidation in the left mid to upper zone with moderate associated pleural effusion. Regions of lucency in the left upper zone suggestive of cavitation. Small nodule in the right mid to upper zone is non-specific.
The findings are typical for infection, although in the context of persistent changes refractory to antibiotics, neoplasia or tuberculosis should be considered.
CT confirms the findings of consolidative change involving both lobes, with more cavitating change at the apex.
The patient proceeded to an FDG PET study.
Moderate FDG avidity in the non-cavitating regions of left upper lobe consolidation. The right upper zone nodule is non FDG avid. Findings are still favored to represent infection, with a differential of malignancy.
The patient proceeded to bronchoscopic biopsy of the left upper lobe infiltrate. Histopathology showed an infiltrate of small atypical lymphocytes with an immunophenotype consistent with marginal zone lymphoma.
Case Discussion
A good example of non-resolving consolidation. Despite the appearances being consistent with infection, the temporal profile and persistence despite antibiotic treatment raises the possibility of lymphoma +/- other malignancy.
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