Presentation
Dyspnea, productive cough and chest pain with previous pulmonary tuberculous infection
Patient Data
CT scout image reveals an ill defined opacity of the right parahilar region. CT images reveal an ill defined, irregular shaped spiculated soft tissue lesion occupying the anterior segment of right upper lobe. There is associated septal thickening, thickening and nodularity of the bronchovascular bundle and lymphadenopathies especially the right hilar, right lower paratracheal and subcarinal groups, some of them show calcification. Mild right pleural effusion is noted.
Diagnosis: Adenocarcinoma in situ of the lung (previously known as bronchogenic adenocarcinoma) (pathology proven) with lymphangitis carcinomatosis.
The red arrows refer to the spicules of the mass which indicate tissue microinvasion.
The green arrows refer to the peribronchovascular thickening and nodularity.
Case Discussion
Lymphangitic spread in the lung occurs with certain types of tumors including adenocarcinoma in-situ of the lung, breast cancer, lymphoma and GIT malignancies. However, they usually produce bilateral parenchymal lung changes. Adenocarcinoma in situ of the lung can produce unilateral affection.
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