Presentation
Chest pain, clinically suspected pulmunary embolism. No significant previous medical history.
Patient Data
No evidence of pulmonary embolus or abnormal lung parenchymal findings.
Multiple ribs and vertebral lytic bone lesions are shown on bone window.
Contrast-enhanced neck CT shows enlarged left tonsil.
Multiple vertebral and pelvic lytic bone lesions.
No evidence of lymphadenopathy or hepato-splenic involvement.
No evidence of other malignant origin.
Case Discussion
Young healthy male, in his thirties, presented to ED with complaints of pleuritic chest pain. Pulmonary embolus was ruled out by chest CTPA. Multiple lytic bone lesions in ribs and thoracic vertebrae were found on bone window. Further evaluation with head, neck and abdominal CT revealed additional skeletal lytic lesios and focal enlargement of left tonsil. Pathology examination from the tonsil revealed follicular lymphoma (grade 3). Bone marrow biopsy pathology examination revealed diffuse large B cell lymphoma of germinal cell origin. The patient was diagnosed with follicular lymphoma transformed to DLBCL.
Courtesy of Dr. Elvira Kaplan.