Niida et al. Journal of Medical Case Reports 2011, 5:295 http://www.jmedicalcasereports.com/content/5/1/295 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Pulmonary intravascular lymphoma diagnosed by 18-fluorodeoxyglucose positron emission tomography-guided transbronchial lung biopsy in a man with long-term survival: a case report Tomiharu Niida1, Kikuo Isoda1*, Koji Miyazaki1, Soichiro Kanoh2, Hideo Kobayashi2, Ayako Kobayashi3, Fumihiko Kimura3, Katsumi Hayashi4, Masatoshi Kusuhara5 and Fumitaka Ohsuzu1 Abstract Introduction: 18-Fluorodeoxyglucose positron emission tomography can detect the pulmonary involvement of intravascular lymphoma that presents no abnormality in a computed tomography scan. Case presentation: We report the case of a 61-year-old Japanese man who had pulmonary intravascular lymphoma and no computed tomography abnormality. We were able to make an antemortem diagnosis of pulmonary intravascular lymphoma by transbronchial lung biopsy according to 18-fluorodeoxyglucose positron emission tomography findings. He is free of recurrent disease 24 months after chemotherapy. Conclusions: To the best of our knowledge, this is the first reported case of a long-term survivor of pulmonary intravascular lymphoma diagnosed by transbronchial lung biopsy under the guide of 18-fluorodeoxyglucose positron emission tomography. Introduction Intravascular lymphoma (IVL), a rare subtype of extrano- dal diffuse large B-cell lymphoma, is characterized by malignant cells that proliferate within small vessels [1]. We recently treated a patient who had pulmonary IVL and who showed no abnormality in computed tomogra- phy (CT) scans. Gallium scintigraphy showed slightly increased opacity in both of his lungs. Conversely, 18- fluorodeoxyglucose positron emission tomography (FDG-PET) revealed strongly increased tracer levels in the lower regions of both lungs. We performed a trans- bronchial lung biopsy (TBLB) according to the FDG accumulation and established a histological diagnosis. In our patient, FDG-PET proved to be more useful in diag- nosing IVL after other radiological modalities - high- resolution computed tomography (HRCT) and gallium scintigraphy - had failed to identify pulmonary lesions. * Correspondence: isoda@ndmc.ac.jp 1Division of Cardiovascular Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan Full list of author information is available at the end of the article This is a case of pulmonary IVL diagnosed by TBLB under the guide of FDG-PET findings. Case presentation A 61-year-old Japanese man with a four-month history of dyspnea was referred to our cardiovascular department because of unexplained dyspnea. His symptoms included low-grade fever (37°C to 38°C), night sweats, and pro- gressive dyspnea on exertion during the preceding month. A physical examination revealed a loud diastolic murmur in his right second intercostal space but no jugular vein distention, respiratory crackles, or leg edema. Laboratory data indicated pancytopenia, inflam- mation, and liver dysfunction. An examination of the blood showed a hemoglobin level of 11.5 g/dL, a hemato- crit level of 33.2%, a platelet count of 8.3 × 104/μL, and a white blood cell count of 5.4 × 103/μL. His serum lactate dehydrogenase (LDH) level was high (698 IU/L, normal range: 100 to 225). His alanine transaminase levels were slightly elevated (aspartate aminotransferase 50 IU/L and alanine aminotransferase 45 IU/L). His C-reactive protein level was 3.1 mg/dL, and his erythrocyte sedimentation © 2011 Niida et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.