Atypical Pulmonary Lymphangitic Metastasis Manifesting as Air-space Lesions: A Case Report

ABSTRACT

Pulmonary lymphangitic carcinomatosis is a common secondary neoplasm of the lung that may result from hematogenous dissemination to small pulmonary arteries and arterioles followed by invasion of the interstitial space and lymphatics, or from the retrograde spread of tumors from mediastinal or hilar lymph nodes. Radiologically, irregular interlobular septal thickening, bronchovascular interstitial thickening and/or lymph node enlargement are observed. In this report, we describe an atypical radiological manifestation of lymphan-gitic metastasis of stomach cancer in a 37-year-old woman admitted for dyspnea on exertion and a cough which had been present for one month. HRCT scanning revealed bilateral multifocal ground glass opacity or consolidation, mild diffuse axial interstitial thickening, and slight pleural effusion. These findings were thought to indicate the existence of an air-space disease rather than metastasis. Open lung and endoscopic biopsy, however, demonstrated the presence of lymphangitic metastasis from stomach cancer.