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Pulmonary Intravascular Lymphomatosis*: Presentation with Dyspnea and Air Trapping

Jeffrey G. Walls, MD; Y. Gia Hong, MD; Joseph E. Cox, MD; Kevin M. McCabe, MD; Kevin E. O’Brien, MD; Jeffrey P. Allerton, MD; Stephen Derdak, DO, FCCP
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*From the Departments of Pulmonary/Critical Care (Drs. Walls and Derdak), Hematology/Oncology (Drs. Hong and Allerton), Radiology (Dr. Cox), Pathology (Dr. McCabe), and Internal Medicine (Dr. O’Brien) Wilford Hall, USAF Medical Center, Lackland AFB, San Antonio, TX.

Correspondence to: Jeffrey G. Walls, MD, Captain, USAF, MC, 2200 Berquist Dr., Suite 1, Wilford Hall Medical Center, Department of Pulmonary/Critical Care Medicine/MMCP, Lackland AFB, TX 78236



Chest. 1999;115(4):1207-1210. doi:10.1378/chest.115.4.1207
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Intravascular lymphomatosis (IVL) is a rare lymphoid neoplasm that is typically of B-cell lineage and characterized by proliferation of malignant cells within small arterioles, capillaries, and venules. We report a patient with pulmonary IVL who presented clinically with progressive dyspnea, fever, and a dry cough. Pulmonary function tests revealed a marked decrease in diffusion capacity with airflow obstruction and severe air trapping. High-resolution CT (HRCT) of the chest with inspiratory and expiratory images revealed mosaic attenuation consistent with air trapping. Transbronchial biopsies revealed the diagnosis of IVL with capillary expansion in the alveolar and peribronchiolar interstitial tissue. IVL should be considered in the differential diagnosis of a patient with an interstitial lung disease, air trapping on pulmonary function tests, and mosaic attenuation on HRCT. Transbronchial biopsies may be the initial diagnostic procedure of choice.

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