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A 72-year-old asymptomatic man was admitted to our hospital with abnormal chest radiographic findings: bilateral diffuse linear, reticular, and consolidated shadows. Malignant lymphoma (diffuse small-cell B-cell lymphoma) was diagnosed histologically after an open lung biopsy and was confirmed by a genetic examination. The lymphoma cells had infiltrated widely in various regions of the lung, including the alveolar spaces and walls, the bronchial and vascular spaces, and the pleura. This diffusion of the lymphoma cells might have accounted for the chest X-ray findings. Malignant pulmonary lymphoma should be included in the differential diagnosis patients with diffuse linear, reticular, and consolidated shadows on chest X-ray films.

Squamous cell carcinoma of the lung was diagnosed in a 64-year-old man. Chest roentgenographic and tomographic examinations did not show areas of high-density in the tumor, but chest CT scan showed diffuse, scattered, high-density nodules in the tumor. Histologic examination did not show calcification, and calcium staining (Kossa method) was negative. Examination of the thin-slice CT, the soft X-ray film, and the resected slice of the lung indicated that the high-density nodules seen in the tumor on the chest CT scan corresponded to markedly fibrotic lesions with severe anthracosis. This case shows that high-density areas on a CT scan may reflect non-calcified lesions.

A 60-year-old woman was admitted to our hospital because of progressive cough and chest pain for 2 months. She also complained of exertional dyspnea. Bilateral diffuse infiltlative shadows were found on the chest roentogenogram. Ground-glass opacity in the middle lobe and lingula, and subpleural patchy consolidation were seen on the computed tomogram of the chest. Arterial oxygenation and diffusing capacity were low. The level of angiotensin-converting enzyme in serum was normal, but that of lysozyme was high. In the BAL (broncho-alveolar lavage) fluid, total cell count and the number of lymphocytes were high, and the CD 4/8 ratio of the lymphocytes was high. Open lung biopsy revealed numerous confluent sarcoid granulomas with necrosis, which strongly correlated with severe vasculitis. After necrotizing sarcoid granulomatosis was diagnosed, prednisolone was administered, which resulted in improvement of symptoms and disappearance of chest-radiograph shadows. Necrotizing sarcoid granulomatosis may be seen as a variant type of sarcoidosis. However, clinical findings including the chest-radiograph shadows and clinical course of this case differ from those of ordinary sarcoidosis. These clinical findings can be attributed to severe vasculitis, as revealed by histological examination.