In a 1990 analysis of a database of patients with RDD, Foucar et al found that of 423 patients, 179 (42.3%) had extranodal involvement and only 33 of those patients (7.8%) had osseous involvement. Nine (2%) of those patients had osseous involvement without lymphadenopathy, as seen in the patient in our study. Since this initial database review, a few other studies have documented patients who presented with solitary or multiple bone lesions as the sole manifestations of RDD.–,,,,, Reported locations of lesions isolated to bone include: skull, spine, femur, radius, ulna, metacarpals, talus, and rib.–, Foucar et al also noted that the most frequently affected upper airway sites were the nasal cavity (50%), pharynx (25%), paranasal sinuses (18.7%), and trachea (6.3%). Involvement of the larynx, lung, and pleura has been reported in only a few cases. Authors of a case report documenting the rare isolated involvement of pleura reported involvement of the lower respiratory tract by RDD to be relatively rare, comprising 3% of extranodal cases. Pulmonary RDD typically involves the tracheobronchial tree, with intraluminal polypoid lesions sometimes associated with airway obstruction. Diffuse interstitial or airspace involvement occurs less frequently; however, when there is extensive parenchymal involvement, the pleura may be involved. Presentation limited to the mediastinum is rare. Only seven cases of tracheal involvement have been reported; of those, five cases were subglottic or laryngeal in location and associated with compromise of the airway.