Case of the Month 6 December 2015

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Presentation transcript:

Case of the Month 6 December 2015 History: 47-yr-old male patient with weight loss and severe back pain.

Case of the Month 6

Case of the Month 6 What is your diagnosis ?

Case of the Month 6 December 2015 History: 47-yr-old male patient with weight loss and severe back pain. Author: Sujal R Desai London Question: What does the CXR show?

Case of the Month 6 Reticulo-nodular pattern Bulky left hilum Bilateral; mid/lower zones Bulky left hilum Smooth thickening of horizontal fissure Normal heart size No pleural effusions

Case of the Month 6 Question: What is shown on the CT images & what is your differential diagnosis

Case of the Month 6 Thickened interlobular septa Thickened right oblique fissure Bronchial wall thcikening Focal sclerotic lesions

Case of the Month 6 What is your diagnosis ?

Lymphangitis Carcinomatosa* Case of the Month 6 Diagnosis Lymphangitis Carcinomatosa* Differential Diagnosis Interstitial Oedema Pulmonary Veno-Occlusive Disease Congenital lymphatic disorders (e.g. lymphangiectasia) Erdheim-Chester Disease * subsequent abdominal MRI and biopsy confirmed diagnosis of a pancreatic tumour

Discussion Case of the Month 6 Dissemination of malignant cells into the pulmonary lymphatics is most commonly associated with cancers of the breast, gastro-intestinal organs (incl. pancreas & stomach) and lung Spread into pulmonary lymphatics may be ‘retrograde’ from hilar nodes into lung lymphatics

Discussion Case of the Month 6 CHEST RADIOGRAPHY Bilateral thickened interlobular septa / Kerley B lines Thickening of fissures (caused by sub-pleural oedema) Pleural effusion(s) HIGH-RESOLUTION CT Thickened, nodular interlobular septa Thickening of bronchovascular bundles Hilar/mediastinal lymph node enlargement

LYMPHANGITIS CARCINOMATOSA Case of the Month 6 Further Reading LYMPHANGITIS CARCINOMATOSA 1) Bruce DM et al. Lymphangitis carcinomatosa: a literature review JR Coll Surg Edinb 1996;41:7-13 2) Kelly DM et al. Pulmonary lymphangitis carcinomatosa and acute pancreatitis: a rare presentation of choledochal cyst HPB Surg 1999;11:163-168 3) Yahng SA et al. Erdheim-Chester disease with lung involvement mimicking pulmonary lymphangitic carcinomatosis Am J Med Sci 2009;337:302-304 4) Honda O et al. Comparison of high resolution CT findings of sarcoidosis, lymphoma, and lymphangitic carcinoma: is there any difference of involved intersitium? J Comput Assist Tomogr 1999;23:374-379