Hodgkin's Disease of the Lung: Roentgen Appearance and Therapeutic Management

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Abstract
Although the involvement of the pulmonary parenchyma in Hodgkin's disease is well known, the subject remains of considerable interest to radiologists. In this communication, a series of 35 cases of Hodgkin's disease of the lung, selected from a survey of 140 histologically proved cases followed in the Radiotherapy Department of the Veterans Administration Hospital (Bronx, N. Y.), is presented to demonstrate the striking variability of the roentgen appearance. The series includes essentially every known pulmonary manifestation of the disease and affords evidence of the challenging complexity of this type of complication, especially from the standpoint of differential diagnosis. Onset with predominantly pulmonary manifestations may lead to erroneous diagnoses such as tuberculosis, pulmonary abscess, sarcoidosis, mycotic infection, or bronchogenic carcinoma, with consequent mismanagement. The prompt diagnosis of the disease is therefore a matter of considerable practical importance. In addition, it is felt that some therapeutic considerations merit emphasis. Historical Review The history of pulmonary Hodgkin's disease has been traced in detail by Wessler and Greene (24), Falconer and Leonard (7), Vieta and Craver (23), and Hoster and Dratman (11) in this country, and by Versé (22), Uehlinger (21), and Perrier (16) abroad. The incidence of involvement of the lung parenchyma has been variously reported, as follows: There is essentially universal agreement as regards the various modes of spread of the disease to the lung. Uehlinger, Versé, Vieta and Craver, and Hoster and Dratman are agreed that the three chief modes of extension of the disease are (a) lymphogenous and (b) hematogenous dissemination from more distant foci and (c) propagation by direct contiguity from a pre-existing focus of involvement in the mediastinal nodal structures. Still another mode of dissemination is that originally described by Wessler and Greene, namely, autochthonous foci developing spontaneously in the lymphoid tissue of the lung. Hoster et al. indicate that the roentgen appearance of the pulmonary lesions may vary according to their origin. Thus, the hematogenous dissemination of the disease would result in diffusely scattered nodules and the lymphatic spread in linear or feathery densities corresponding to the distribution of the peribronchial lymphatics. Those lesions which develop as a result of direct extension would radiate from the hilar area to involve a variable segment of pulmonary parenchyma. Perrier postulates that ultimately Hodgkin's disease is featured by successive episodes of generalization and that the pulmonary lesions closely mirror the occurrence and degree of dissemination. A corollary opinion is expressed by Vieta and Craver, who state that the entire lymphatic system seems to react as a whole to the exciting agent responsible for the disease.

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