Lymphomatoid granulomatosis in a pediatric patient $ Joseph P. Mazzie a , Anita P. Price a , Poonam Khullar b , Carlos H. Montoya c , Jon E. Roberts c , Haesoon Lee c , Lewis Williams d , Allan Schuss b , Douglas S. Katz a, * a Department of Radiology, Winthrop-University Hospital, 259 First Street, Mineola, NY 11501, USA b Department of Pathology, Winthrop-University Hospital, Mineola, NY, USA c Department of Pediatrics, Winthrop-University Hospital, Mineola, NY, USA d Department of Surgery, Winthrop-University Hospital, Mineola, NY, USA Received 20 July 2003 Abstract We report the radiology and pathology of a pediatric patient with lymphomatoid granulomatosis (LG) and review the literature, with an emphasis on the radiological findings and on the small subset of pediatric patients with this rare condition. D 2004 Elsevier Inc. All rights reserved. Keywords: Lymphomatoid granulomatosis; Lung; Children; Computed tomography Lymphomatoid granulomatosis (LG), which is also known as angiocentric lymphoma and angiocentric immu- noproliferative lesion [1], was originally described by Lie- bow et al. [2] in 1972. LG is a rare entity in children, occurring in only one child out of 40 patients with the condition, in Liebow’s original series. LG was defined as an angiocentric and angiodestructive lymphoreticular prolifer- ative and granulomatous disease involving predominately the lungs, but which could frequently involve other organs such as the skin, central nervous system, and kidneys [2]. In this Radiology – Pathology Conference, the clinical presen- tation and imaging findings of a patient with LG are reviewed. To our knowledge, there are only a few reports of the computed tomography findings in LG in adults and even fewer in children. 1. Case presentation A 16-year-old male was presented at our hospital with cough, chest tightness, and 101 jF temperature. The patient was hospitalized several weeks prior to this admission for respiratory distress and bilateral air-space disease believed to be pneumonia (Fig. 1A); the patient had required intu- bation during that admission. Serial chest radiographs showed marked interval improvement over a 3-week period (Fig. 1B), but computed tomography prior to discharge demonstrated residual pulmonary nodules in the mid and lower lungs (Fig. 1C–D). A review of systems on the current admission was positive only for chest pain and cough. On initial physical examination, the patient had a heart rate of 98, a respiratory rate of 24, and a blood pressure of 109/53. On examination of the lungs, it was noted that the patient had decreased breath sounds at the bases posteriorly, but there were no wheezes, rhonchi, or rales. The remainder of the physical examination was unremarkable. The white count was 3,000 with 68% polys and 19% lymphocytes. The absolute neu- trophil count was 1800. Chest radiography showed conflu- ent pulmonary nodules and recurrent areas of air-space disease (Fig. 1E). The patient was admitted to the pediatric intensive care unit and was started on IV antibiotics. Despite antibiotic treatment, the patient’s fever increased and the patient started to desaturate. CT scan of the chest (Fig. 1F–G) was then obtained, which demonstrated large bilateral basilar confluent pulmo- nary nodules and areas of air-space disease. Tissue sampling was recommended. The patient subsequently underwent 0899-7071/04/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/S0899-7071(03)00237-7 $ From the monthly Radiology– Pathology Conferences at Winthrop- University Hospital. * Corresponding author. Tel.: +1-516-663-3800; fax: +1-516-663-8172. E-mail address: dsk2928@pol.net (D.S. Katz). Journal of Clinical Imaging 28 (2004) 209 – 213