CHEST Guidelines-An-82-Year-Old-Woman-With-Left-Upper-Lobe-Atelecta

An-82-Year-Old-Woman-With-Left-Upper-Lobe-Atelecta

Pdf Summary

An 82-year-old woman presented to the pulmonary clinic with persistent shortness of breath and a cough. Despite treatment with bronchodilators, antibiotics, and steroids, her symptoms did not improve. A lifelong nonsmoker, her medical history included a colectomy due to malignant colon polyps five years ago. Initial examinations, including a CBC and basic metabolic panel, were unremarkable, yet a chest radiograph and CT scan revealed atelectasis in the left upper lobe. Bronchoscopy showed an endobronchial lesion obstructing part of her bronchus, which upon biopsy, showed atypical lymphoid tissue indicative of lymphoma. <br /><br />Further testing, including PET-CT scans and flow cytometric analysis, revealed increased FDG uptake and lymphadenopathy, but no overt B-cell proliferative disorder in the blood. Repeat bronchoscopy allowed for more tissue sampling, confirming a diagnosis of diffuse large B-cell lymphoma (DLBCL), a rare form of primary pulmonary lymphoma (PPL). This type of lymphoma, although the most common form of PPL, constitutes a small percentage of non-Hodgkin's lymphoma cases.<br /><br />While often linked to immunosuppression, DLBCL can also appear in older immunocompetent individuals, typically presenting with respiratory symptoms. In this case, radiographic evaluations showed an endobronchial lesion causing lobar collapse. Although endobronchial biopsy is not commonly the primary diagnostic tool, it was successful here. Treatment involved chemotherapy with R-CHOP, leading to rapid improvement and almost complete resolution of symptoms. <br /><br />Prognosis for DLBCL varies based on factors like lactate dehydrogenase levels and lymphadenopathy at diagnosis. Despite these factors suggesting poor outcomes, the patient's response to treatment has been favorable. Ultimately, early detection and appropriate chemotherapy can lead to good long-term survival in patients diagnosed with DLBCL.

Keywords

diffuse large B-cell lymphoma

primary pulmonary lymphoma

endobronchial lesion

atelectasis

R-CHOP chemotherapy

non-Hodgkin's lymphoma

elderly patient

immunocompetent

bronchoscopy

lung cancer diagnosis