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

2. Case of the Month 6

3. Case of the Month 6
What is your diagnosis ?

5. 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?

6. 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

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

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

9. Case of the Month 6
What is your diagnosis ?

10. 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

11. 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

12. 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

13. 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:
3) Yahng SA et al. Erdheim-Chester disease with lung involvement mimicking pulmonary lymphangitic carcinomatosis Am J Med Sci 2009;337:
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: