Posters
Presentation Type
Poster
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Introduction: Hodgkin's lymphoma is a malignancy of the lymphatic system characterized by the presence of Reed-Sternberg cells. B symptoms, lymphadenopathy of the cervical and/or supraclavicular nodes, and mediastinal mass are some common initial clinical manifestations of Hodgkin’s lymphoma. This abstract presents a case study of a 33-year-old man diagnosed with type IV classic type nodular Hodgkin’s lymphoma who presented with brachiocephalic vein compression, resulting in left chest wall edema. This case highlights the importance of recognizing and investigating uncommon presentations of Hodkin's lymphoma to ensure timely diagnosis and management.
Case: A 33-year-old man without significant past medical history presented with worsening shortness of breath on exertion and the swelling of the left chest wall and arm in the setting of enlarging mass in the left supraclavicular area for four months. Physical examination revealed evidence of the left supraclavicular adenopathy and edema of the left chest wall and arm. He had decreased breath sounds and dullness to percussion two-thirds of the way up on the left lung. A chest radiograph revealed an extensive left pleural effusion for which he underwent thoracentesis. Fluid analysis from left thoracentesis revealed a malignant pleural effusion. A CT of the chest, abdomen, and pelvis revealed multiple confluent lymphadenopathies in the prevascular, left supraclavicular, axillary, high paratracheal, bilateral perihilar, and epiphrenic region, as well as left moderate pleural effusion, mild right pleural effusion, and mild pericardial effusion, and the evidence of stenosis of the left brachiocephalic vein from the lymphadenopathy. He underwent an excisional biopsy of one of the supraclavicular lymph nodes, with final pathology revealing classical Hodgkin lymphoma, nodular sclerosing type. The patient was referred to an interventional radiologist for a stent placement of the left brachiocephalic vein and was started on doxorubicin, vinblastine, dacarbazine(AVD), and brentuximab therapy.
Discussion: This case report underscores the importance of considering Hodgkin's lymphoma as a differential diagnosis in patients with unusual manifestations such as chest wall edema. Chest wall edema can be a rare presenting feature of Hodgkin's lymphoma, and its underlying etiology should be carefully evaluated. In this case, the left brachiocephalic vein was externally compressed from the mediastinal lymphadenopathy leading to left chest wall edema. Prompt recognition and multidisciplinary management, including vascular intervention and chemotherapy, would be optimal in bringing a favorable outcome for the patient. Awareness and recognition of the atypical presentations of Hodgkin's lymphoma are needed to improve early detection and optimize treatment outcomes.
Academic/Professional Position
Resident
Recommended Citation
Cho, Eunbee, "Hodgkin's Lymphoma-Associated Thoracic Central Venous Obstruction" (2024). Research Symposium. 3.
https://scholarworks.utrgv.edu/somrs/2023/posters/3
Included in
Hodgkin's Lymphoma-Associated Thoracic Central Venous Obstruction
Introduction: Hodgkin's lymphoma is a malignancy of the lymphatic system characterized by the presence of Reed-Sternberg cells. B symptoms, lymphadenopathy of the cervical and/or supraclavicular nodes, and mediastinal mass are some common initial clinical manifestations of Hodgkin’s lymphoma. This abstract presents a case study of a 33-year-old man diagnosed with type IV classic type nodular Hodgkin’s lymphoma who presented with brachiocephalic vein compression, resulting in left chest wall edema. This case highlights the importance of recognizing and investigating uncommon presentations of Hodkin's lymphoma to ensure timely diagnosis and management.
Case: A 33-year-old man without significant past medical history presented with worsening shortness of breath on exertion and the swelling of the left chest wall and arm in the setting of enlarging mass in the left supraclavicular area for four months. Physical examination revealed evidence of the left supraclavicular adenopathy and edema of the left chest wall and arm. He had decreased breath sounds and dullness to percussion two-thirds of the way up on the left lung. A chest radiograph revealed an extensive left pleural effusion for which he underwent thoracentesis. Fluid analysis from left thoracentesis revealed a malignant pleural effusion. A CT of the chest, abdomen, and pelvis revealed multiple confluent lymphadenopathies in the prevascular, left supraclavicular, axillary, high paratracheal, bilateral perihilar, and epiphrenic region, as well as left moderate pleural effusion, mild right pleural effusion, and mild pericardial effusion, and the evidence of stenosis of the left brachiocephalic vein from the lymphadenopathy. He underwent an excisional biopsy of one of the supraclavicular lymph nodes, with final pathology revealing classical Hodgkin lymphoma, nodular sclerosing type. The patient was referred to an interventional radiologist for a stent placement of the left brachiocephalic vein and was started on doxorubicin, vinblastine, dacarbazine(AVD), and brentuximab therapy.
Discussion: This case report underscores the importance of considering Hodgkin's lymphoma as a differential diagnosis in patients with unusual manifestations such as chest wall edema. Chest wall edema can be a rare presenting feature of Hodgkin's lymphoma, and its underlying etiology should be carefully evaluated. In this case, the left brachiocephalic vein was externally compressed from the mediastinal lymphadenopathy leading to left chest wall edema. Prompt recognition and multidisciplinary management, including vascular intervention and chemotherapy, would be optimal in bringing a favorable outcome for the patient. Awareness and recognition of the atypical presentations of Hodgkin's lymphoma are needed to improve early detection and optimize treatment outcomes.