eMedicine Specialties > Radiology > Chest

Hodgkin Disease, Thoracic: Follow-up

Author: Narainder Gupta, MBBS, MSc, FRCR, MD, Assistant Professor of Cardiothoracic Radiology, Division Director, Division of Cardiothoracic Radiology, Thomas Jefferson University Hospital
Coauthor(s): Jamshed B Bomanji, MBBS, MSc, PhD, Consulting Staff, Institute of Nuclear Medicine, Middlesex Hospital; Nuclear Medicine Consultant, University College Hospital
Contributor Information and Disclosures

Updated: Jan 21, 2009

Intervention

Interventional radiology is primarily used to help perform transthoracic needle biopsies (TNB). The indications for TNB are isolated mediastinal or hilar adenopathy, pleural or chest wall involvement, diffuse pleural thickening, and distinction of lymphoma from primary mediastinal masses. TNB is usually CT guided, but other techniques such as fluoroscopy, continuous CT fluoroscopy, and ultrasonography can also be used. The complications of TNB include pneumothorax, bleeding, stroke, pericarditis, vasovagal reaction, and systemic air embolization.

Other possible interventions in thoracic Hodgkin disease include pleural drainage under ultrasonography guidance and drainage of postbiopsy pneumothorax under either fluoroscopy or CT guidance. For relief of the symptoms of SVC syndrome, SVC stenting is occasionally performed under fluoroscopic guidance.

Medicolegal Pitfalls

  • Subtle adenopathy can be missed on chest radiographs.
  • When using chest radiographs alone, the diagnosis can be missed altogether, or an accurate diagnosis can be delayed.

Special Concerns

  • The incidence of Hodgkin disease is increased in patients with HIV infection. Hodgkin disease in these patients usually appears as advanced extranodal disease, with aggressive tumoral behavior and short survival rates in most patients. Almost 67%of patients present with extranodal disease , and almost 50% present with bone marrow involvement. The frequency of mixed-cellularity and lymphocytic-depletion types is increased compared with the frequency in patients without HIV infection.
  • Because of the successful therapies available for the treatment of patients with early-stage Hodgkin disease, patients live longer and have a higher risk of developing a second malignancy. Second malignancies are related to the extent of treatment for Hodgkin disease. There are no studies or consensus concerning how to best conduct the ongoing surveillance for second malignancies. Proper history taking, examinations, and appropriate studies (including radiologic studies) should be conducted on the basis of the patient's symptoms or any abnormal findings on physical examination.
 
Acknowledgments

Special thanks are extended to Dr. Jeremy Lawrance for his contributions to this topic.



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References
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Further Reading

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Keywords

Hodgkins disease, Hodgkin's disease, Hodgkin disease, Hodgkins, Hodgkin's, lymphoma, Hodgkin lymphoma, Hodgkin's lymphoma, Epstein-Barr virus

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Contributor Information and Disclosures

Author

Narainder Gupta, MBBS, MSc, FRCR, MD, Assistant Professor of Cardiothoracic Radiology, Division Director, Division of Cardiothoracic Radiology, Thomas Jefferson University Hospital
Narainder Gupta, MBBS, MSc, FRCR, MD is a member of the following medical societies: American Roentgen Ray Society, Radiological Society of North America, Royal College of Radiologists, and Society of Thoracic Radiology
Disclosure: Nothing to disclose.

Coauthor(s)

Jamshed B Bomanji, MBBS, MSc, PhD, Consulting Staff, Institute of Nuclear Medicine, Middlesex Hospital; Nuclear Medicine Consultant, University College Hospital
Jamshed B Bomanji, MBBS, MSc, PhD is a member of the following medical societies: British Medical Association, Medical Protection Society, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

Medical Editor

Kitt Shaffer, MD, PhD, Director of Undergraduate Medical Education, Associate Professor, Department of Radiology, Cambridge Health Alliance
Kitt Shaffer, MD, PhD is a member of the following medical societies: American Roentgen Ray Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

John D Newell, Jr, MD, FACR, FCCP, FASER, Co-Director of Thoracic Imaging, UCDHSC; Director of Lung Imaging Center, Professor of Radiology and Professor of Medicine, Department of Radiology, University of Colorado Health Sciences Center, National Jewish Medical and Research Center; Univ. Colorado Hospital
John D Newell, Jr, MD, FACR, FCCP, FASER is a member of the following medical societies: American College of Chest Physicians, American College of Radiology, American Roentgen Ray Society, American Thoracic Society, Association of University Radiologists, Radiological Society of North America, and Society of Thoracic Radiology
Disclosure: Siemens Medical Grant/research funds Consulting; Forevision Technologies Ownership interest Consulting; Vida Corporation Ownership interest Board membership; TeraRecon Grant/research funds Consulting; eMedicine Honoraria Consulting

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

 
 
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