Because of the positive ANCA test result, associations between lymphoma and Wegener granulomatosis (WG) deserve further consideration. The radiographic spectrum of WG involving the lungs is variable. The observed bilateral patchy areas of airspace disease including ground-glass infiltrates and consolidation could represent alveolar hemorrhage, one of the typical features of WG or microscopic polyangiitis. The disease defining cavitary nodules of WG resulting from the necrotizing granulomatous inflammation are rare in pulmonary lymphoma. Even though mediastinal, hilar, and peripheral lymphadenopathy may occur in WG, their presence is rare (2%) and should prompt the search for alternative explanations. Lymphomas have long been recognized as complications of cytotoxic therapy for WG. Alternatively, sinonasal NHL and lymphomatoid granulomatosis can mimic WG. Hodgkin lymphoma, T-cell and B-cell NHL, lymphomatoid granulomatosis, and intravascular lymphoma have all been reported as presenting like WG or in association with documented WG. Paraneoplastic vasculitis, myelodysplasia, and other lymphoproliferative disorders have also been associated with ANCA. However, to our knowledge, matching PR3-ANCA with cANCA, which are typical for WG, have not been reported in lymphoma or hematologic disorders.