CT-Imaging Manifestations and Diagnostic Insights in Pulmonary Intravascular Large B-Cell Lymphoma: A Case Series and Literature Review.

Background: Intravascular large B-cell lymphoma (IVLBCL) is a rare and aggressive subtype of non-Hodgkin lymphoma. Although autopsy findings have revealed that IVLBCL often involves the lungs, its clinical features and imaging manifestations have rarely been reported. This study aimed to explore the pulmonary imaging manifestations of three patients with pulmonary IVLBCL.

Case: We retrospectively reviewed the clinical data and chest computed tomography (CT) images of three patients diagnosed with pulmonary IVLBCL between January 2010 and July 2023 in our hospital. In this case series, three patients (2 males and 1 female, aged 51-65 years) presented with a variety of symptoms. Laboratory tests revealed elevated lactate dehydrogenase levels in all three individuals. Chest CT scans revealed bilateral ground-glass opacities (GGOs) in the lungs in all cases. Although previous case reports have often depicted GGOs as ill-defined, two of the three cases manifested multiple well-circumscribed GGOs. Two cases underwent fluorodeoxyglucose positron emission tomography (FDG) PET/CT scans, which showed increased FDG uptake in pulmonary lesions (SUVmax values of 1.9 and 1.7, respectively).

Conclusion: Chest CT images of patients with pulmonary IVLBCL mainly manifested as bilateral GGOs of the lungs, with ill-defined GGO infiltrations being more common. FDG PET/CT demonstrates high diagnostic sensitivity for detecting pulmonary involvement in IVLBCL. Even when chest CT scans reveal no visible abnormalities, FDG PET/CT can detect enhanced metabolic uptake in areas with lesions for certain patients.