Lymphangitic Carcinomatosis of the Lungs with Normal Appearing Chest X-Ray Films

Alkalay, I; Fairfax, Charles W.; Bullard, John C.

doi:10.1378/chest.62.2.229

Cited by 15 publications

(4 citation statements)

References 4 publications

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“…Diagnosis becomes possible when PLC is highly suspected and it becomes extremely difficult when PLC is the result of occult cancer. In some cases the chest roentgenogram is negative [5][6][7]12] or shows bilateral reticulonodular infiltrates with or without hilar adenopathy, thus suggesting interstitial pulmonary disease or sarcoidosis. In fact, in a reported case of PLC involving a colon carcinoma [13], a whole-body scan with 67 Ga was also performed and failed to show any abnormalities.…”

Section: Discussionmentioning

confidence: 99%

“…Other primary sites, such as the pancreas, colon, esophagus, prostate, gallbladder and thyroid have also been reported [2][3][4]. Antemortem diagnosis is rather uncommon, since many of these patients have normal or nonspecific chest X-ray or CT findings [5][6][7]. Progressive dyspnea resulting from pulmonary involvement may be the only symptom in the early stage.…”

Section: Introductionmentioning

confidence: 99%

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The ‘Fragmented’ Scintigraphic Lung Pattern in Pulmonary Lymphangitic Carcinomatosis Secondary to Breast Cancer

Vattimo

Burroni²,

Bertelli³

et al. 1998

Respiration

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Pulmonary lymphangitic carcinomatosis (PLC) is an unusual presentation of diffuse infiltrative lung disease. In this report we present two cases secondary to breast cancer; the diagnosis was made by means of transbronchial lung biopsy or postmortem examination. The goal of this study was to analyze the scintigraphic pattern of pulmonary perfusion performed with technetium-99m macroaggregated albumin (^99mTc-MAA) in the hope of achieving improved recognition of PLC and its subsequent diagnosis. Upon admission, both patients underwent routine clinical exams followed by chest X-rays. The second patient also underwent CT examination, and both were ultimately examined using pulmonary perfusion scintigraphy with ^99mTc-MAA. In the various exams performed, the most reliable and easily identified diagnostic finding turned out to be a characteristic ‘fragmented’ lung pattern revealed with the perfusion lung scan. Unfortunately, in both cases the patients’ conditions rapidly worsened and death occurred shortly following scintigraphy. We were able to conclude that the recognition of the mentioned fragmented scintigraphic lung pattern may be useful in suspected PLC, whereas the nonspecific clinical presentation of this pathology makes diagnosis extremely difficult, with the most significant results being achieved through a comparison of scintigraphic and high resolution CT data.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The ‘Fragmented’ Scintigraphic Lung Pattern in Pulmonary Lymphangitic Carcinomatosis Secondary to Breast Cancer

Vattimo

Burroni²,

Bertelli³

et al. 1998

Respiration

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“…5 Patients may have normal x-ray films of the chest. 6 Finally, incipient alveolar processes, such as acute lung injury, may be associated with relatively normal radiographs of the chest and pulmonary hypertension, but in the rare cases with frank right-sided heart failure the disease has usually entered a fibroproliferative phase. Thus, with the exception of lymphangitic carcinomatosis, I can rule out primary diseases of the airways, interstitium, or alveoli.…”

Section: Case 19-1995 P Resentation Of C Asementioning

confidence: 99%

Case 19-1995

Systrom¹,

Mark²

1995

N Engl J Med

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A 55-year-old woman was admitted to the hospital because of acute respiratory distress and thrombocytopenia.The patient had been in stable health until several weeks earlier, when an upper respiratory tract infection developed, with vague, diffuse abdominal pain; ofloxacin and ketorolac were prescribed. One week before admission nausea and vomiting occurred.Three days before admission the patient was admitted to another hospital, where physical examination was normal except for dehydration. Laboratory studies were performed (Tables 1 and 2). Ofloxacin was discontinued, and fluids were administered intravenously. During the next two days the platelet count declined to 27,000 per cubic millimeter. At 6 a.m. on the third hospital day the patient was found to be in severe respiratory distress, with pain in the right shoulder and cyanosis. An electrocardiogram showed sinus tachycardia at a rate of 118, with an R-wave axis of ϩ 93 degrees, incomplete right-bundle-branch block, and a prominent S wave in lead V 1 ; the T waves were inverted in leads III, aVF, and V 1 through V 4 . A radiograph of the chest (Fig. 1) was normal except for cardiac enlargement. Arterial blood gases were measured (Table 3). An attempt at ventilation scanning was unsuccessful because of the patient's severe dyspnea and inability to cooperate; a perfusion scan indicated a low probability of a pulmonary embolus. A cardiac ultrasonographic examination showed dilatation of the right ventricle, with an akinetic wall. There was evidence of pulmonary hypertension and of paradoxical septal motion. No thrombus was detected within the right ventricle. An ultrasonographic examination of the abdomen revealed a diffusely increased echographic texture of the liver; Table 1. Hematologic Laboratory Findings.

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“…The chest radiographs have even been reported as normal in association with PLc. 3,4 Lung scanning techniques can be suggestive of PLC5 and one author postulates instituting chemotherapy based on lung scans without bi-opsy confirmation. * The specific characteristics of PLC on the perfusion lung scan are individually smaller and more numerous defects that outline the bronchopulmonary segments, which is distinctly diffrent from thromboembolism in which there is absent or decreased perfusion throughout the segment or subsegment.…”

Section: Commentmentioning

confidence: 99%

Pulmonary lymphangitic carcinomatosis from hypopharyngeal adenosquamous carcinoma

1988

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Although pulmonary lymphangitic carcinomatosis (PLC) is not uncommon for breast, bronchial, and stomach cancers, it is rarely associated with head and neck malignancy. A case of PLC is reported with the primary lesion being an adenosquamous carcinoma of the hypopharynx. A literature review is discussed, highlighting the varied radiographic picture of PLC, the possible diagnostic modalities, the proposed pathogenesis, and the treatment options. The prognosis even if antemortum diagnosis and treatment are given remains fatal, although with temporary improved quality of life and lengthened survival. There is hope that with greater awareness of the disease process an increased incidence of diagnosis may allow progress to be made in therapeutic interventions.

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Lymphangitic Carcinomatosis of the Lungs with Normal Appearing Chest X-Ray Films

Cited by 15 publications

References 4 publications

The ‘Fragmented’ Scintigraphic Lung Pattern in Pulmonary Lymphangitic Carcinomatosis Secondary to Breast Cancer

The ‘Fragmented’ Scintigraphic Lung Pattern in Pulmonary Lymphangitic Carcinomatosis Secondary to Breast Cancer

Case 19-1995

Pulmonary lymphangitic carcinomatosis from hypopharyngeal adenosquamous carcinoma

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