Scintigraphic evaluation of a patient with lung cavitations: Ga-67 scintigraphy is nondiagnostic

Primary nonHodgkin's lymphoma (NHL) of the lung is an uncommon neoplasm and accounts for only 0.34-0.4% of all NHL. The most common type is the low grade-small lymphocytic lymphoma (50-70%). More than half of the patients are asymptomatic at the time of diagnosis when a mass is discovered on a routine chest x-ray. Pulmonary involvement in patients with lung lymphoma poses considerable diagnostic and management problems. Both the altered immune status and the effects of the combined chemo-radio therapy on the lung may cause a wide range of pulmonary complications such as infection, drug induced pneumonitis, and hemorrhage. The clinical presentation and imaging in lung lymphoma may not always be helpful in making the diagnosis. A patient with high-grade primary NHL of the lung that masked as a prolonged febrile disease with multiple lung cavities was initially thought to be a lung abscess. The intense Ga-67 uptake could not differentiate between an infectious and neoplastic process. It's disappearance after chemotherapy established its origin to be neoplastic. Ga-67 could therefore serve as an adjunct for staging as well as the follow-up of this rare condition.