Presentation
Biopsy proven gastric adenocarcinoma, chest CT for metastatic work up.
Patient Data
There is extensive, bilateral, smooth and nodular interlobular septal thickening. Marked peribronchovascular thickening and few subpleural nodules are also seen. In the mediastinal window, multiple enlarged bilateral hilar, mediastinal and intra-abdominal lymph nodes involving multiple nodal groups are noted. There are also small bilateral pleural cavity fluid collections. In the included abdomen, an irregular thickening of the gastric antrum is noted, representing the primary tumor. Mild dilation of the intrahepatic ducts is also seen, likely due to encasement/compression of the CBD by the periportal nodal mass.
Case Discussion
The findings of extensive interlobular septal thickening, peribronchovascular thickening, diffuse lymphadenopathy and pleural effusion are all strongly suggestive of lymphangitic carcinomatosis. Gastric adenocarcinoma is the third most common malignancy known to give such pattern of lung metastasis.
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