Occult pulmonary lymphangitic carcinomatosis presenting as ‘chronic cough’ with a normal HRCT chest

Abstract

A diagnosis of ‘chronic cough’ (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of ‘chronic cough’ and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported.

A Rare Case of Isolated Chronic Cough Caused by Pulmonary Lymphangitic Carcinomatosis as a Primary Manifestation of Rectum Carcinoma

“…Thickened bronchovascular shadows, diffuse reticulonodular shadows, Kerley lines, hilar lymphadenopathy, and pleural effusion are observed in 20% to 50% of cases ( 5 ). However, chest X-rays show no abnormality in 30% to 50% of cased, as was a reported case by Jinnur et al ( 4 ). They reported a patient with occult pulmonary lymphangitic carcinomatosis solely presenting with chronic cough in whom chest X-ray and high-resolution CT showed no remarkable findings ( 4 ).…”

“…However, chest X-rays show no abnormality in 30% to 50% of cased, as was a reported case by Jinnur et al ( 4 ). They reported a patient with occult pulmonary lymphangitic carcinomatosis solely presenting with chronic cough in whom chest X-ray and high-resolution CT showed no remarkable findings ( 4 ). Body weight loss, decreased appetite, and worsening cough developed 11 weeks after initial chest CT.…”

“…Body weight loss, decreased appetite, and worsening cough developed 11 weeks after initial chest CT. Follow-up chest CT four months later revealed diffused pulmonary nodules with thickening of the bronchovascular bundle in both lungs ( 4 ). This suggests that cough may be the earliest sign of occult pulmonary lymphangitic carcinomatosis among other respiratory symptoms, such as shortness of breath and hemoptysis.…”

“…Among lung tumors, pulmonary lymphangitic carcinomatosis shows a poor prognosis of three to six months ( 3 ). Respiratory symptoms, such as cough, dyspnea, and hemoptysis, progress rapidly and are usually accompanied by body weight loss, appetite loss, and a fever ( 4 , 5 ).…”