CASE 4469 Published on 03.06.2008

Unilateral lymphangitis carcinomatosis

Section

Chest imaging

Case Type

Clinical Cases

Authors

Dr Sivadas Ganeshalingam

Patient

64 years, female

Clinical History
The patient presented with symptoms of a lower respiratory tract infection. The lingular and left lower lobe reticular opacification failed to resolve with antibiotics. The HRCT showed unilateral lymphangitic carcinomatosis. The chest CT demonstrated a soft tissue lesion around the left lower bronchus, bilateral hilar lymphadenopathy and unilateral pleural effusion.
Imaging Findings
The patient presented to her general practioner with symptoms suggestive of a lower respiratory tract infection. Initial chest radiograph (figure 1) demonstrates lingular and left lower lobe reticular opacification which persisted on the follow up chest radiograph despite antibiotic treatment. CT thorax and High Resolution CT was subsequently performed. The volume acquisition CT thorax (figure 2) demonstrated a soft tissue mass encasing the left lower lobe bronchus. Left basal pleural thickening and effusion (figure 3) and bilateral hilar lymphadenopathy (figure 4) was identified.
The HRCT demonstrated unilateral lymphangitic carcinomatosis characterised by thickening of the interlobular septae. The histology from the transbronchial biopsy demonstrated small cell lung cancer.
Discussion
Lymphangitic carcinomatosis represents 7% of pulmonary metastases. The most common primaries are bronchogenic carcinoma which is associated with unilateral disease, breast, stomach, thyroid, pancreas and cervical cancer. The chest radiograph has an accuracy of 23% although it is commonly nonspecific. Classical chest radiograph appearances include reticular opacification, coarsened bronchovascular markings, Kerley A and B lines and small volume lungs. This case demonstrated classical HRCT appearances of lymphangitic carcinomatosis. These include irregular, nodular and smoothly thickened interlobular septae. Typically there is thickening of the fissures due to involvement of the lymphatic vessels concentrated in the subpleural interstitium. There is preservation of normal pulmonary
prenchyma at the level of the secondary lobule. In addition subpleural thickening, pleural effusions (30-50%) and hilar and mediastinal lymphadenopathy (30-50%) can be seen.
Differential Diagnosis List
Bronchogenic carcinoma with unilateral lymphangitic carcinomatosis
Final Diagnosis
Bronchogenic carcinoma with unilateral lymphangitic carcinomatosis
Case information
URL: https://eurorad.org/case/4469
DOI: 10.1594/EURORAD/CASE.4469
ISSN: 1563-4086