Axial CT chest on this 17 year-old female shows a cavitating pulmonary nodule. There were multiple other cavitating and non-cavitating pulmonary nodules, and extensive mediastinal lymphadenopathy. Lung and lymph node biopsy showed nodular sclerosing Hodgkin’s lymphoma.

Primary involvement of the lung is relatively rare in Hodgkin’s disease. This may manifest as direct extension from hilar nodes, or as small peripheral nodules, which may or may not be cavitating. Other patterns include masses, mass-like consolidation, or diffuse interstitial thickening. Lung involvement without mediastinal nodal involvement is extremely rare in primary disease. In recurrent disease pulmonary parenchymal involvement is more common, and may occur without nodal enlargement.

Reference: Guermazi A, et al. Extranodal Hodgkin Disease: Spectrum of Disease. RadioGraphics 2001; 21:161–179

Credit: Dr Laughlin Dawes