Learning objectives
Review the imaging features of emergency room (ER) presentations of lymphoma.
Discuss the role of different imaging modalities in the evaluation of lymphoma and differentiate between lymphoma and its mimics.
Background
According to the 2016 CDC data, there are 22 new lymphoma cases per 100,000 population every year, the seventh leading cause of new cancers. Of these, 40% of patients present to the ER with acute symptoms at the time of initial diagnosis [1]. Imaging has a crucial part in suggesting an early diagnosis of lymphoma, allowing for rapid treatment initiation, which eventually might affect patient prognosis. The imaging manifestations of lymphoma, especially in the ER setting, are many and varied, making the diagnosis difficult and...
Findings and procedure details
This review will demonstrate the imaging manifestations of nodal and extranodal Non-Hodgkin lymphoma in the ER setting at the time of acute presentation with a systemic approach.
In general, lymphomas demonstrate similar imaging features independent of their location. Lesions are typically homogenous and hypoechoic on ultrasound. CT frequently demonstrates hypodense lesions with homogenous contrast enhancement. Rarely, lesions may demonstrate heterogeneous enhancement with necrosis. On MRI, the lesions are usually iso/ hypointense on T1-weighted imaging (T1WI), hyperintense on T2-weighted images (T2WI) with a similar enhancement pattern...
Conclusion
Lymphoma can have an acute clinical presentation that brings the patient to the ER, where the diagnosis is suggested by the radiologist based on the imaging manifestations. Hence, it is critical for the ER radiologist to be aware of and consider the diagnosis when appropriate, allowing for early diagnosis and intervention, thereby affecting patient prognosis and long-term survival.
Personal information and conflict of interest
B. U. Vardar:
Nothing to disclose
N. Modi:
Nothing to disclose
B. Midkiff:
Nothing to disclose
P. Prakash:
Nothing to disclose
References
Kane E, Howell D, Smith A, Crouch S, Burton C, Roman E, et al. Emergency admission and survival from aggressive non-Hodgkin lymphoma: A report from the UK's population-based Haematological Malignancy Research Network. Eur J Cancer. 2017;78:53-60 doi:10.1016/j.ejca.2017.03.013.
Weerakkody Y, Gaillard F.Orbital lymphoma. Available from: URL: http://radiopaedia.org/articles/orbital-lymphoma.
Vaidya R, Habermann TM, Donohue JH, Ristow KM, Maurer MJ, Macon WR, et al. Bowel perforation in intestinal lymphoma: incidence and clinical features. Annals of oncology : official journal of the European Society for Medical Oncology. 2013;24(9):2439-43 doi:10.1093/annonc/mdt188.
Wong-You–Cheong...