Chest Imaging

Bronchioalveolar cell carcinomatosis

subtype of adenocarcinoma of the lung (see adenocarcinoma pulmonary) accounting for less than 5% of all lung cancers. Pathologically, it consists of a peripheral neoplasm in which the malignant cells use the surrounding alveolar walls as a scaffold. The cells produce mucus sometimes in such large amounts that expectoration of mucoid sputum may become a major presenting symptom. Bronchioloalveolar cell carcinoma may present three distinct radiological patterns. The most common is a solitary pulmonary nodule, peripheral in location with ill-defined and hazy contours. On CT scans, the nodule frequently contains an air bronchogram and/or small bubble-like lucencies suggestive of pseudocavitation. Less characteristically, the nodule may appear homogeneously dense with irregular or spiculated contours, often associated with pleural retraction. The second pattern consists of lobar consolidation mimicking pneumonia (Fig.1), sometimes associated with nodules in the same lobe, other lobes or the contralateral lung. This reflects the presumed dissemination of the tumour through the tracheobronchial tree. The finding of a so-called angiogram sign may be seen on CT scan. The third pattern occurs in only a small minority of patients. It consists of multiple nodules scattered throughout both lungs, measuring 3-10 mm in diameter, having very irregular margins (Fig.2), and only rarely appearing cavitated. The prognosis of bronchioloalveolar carcinoma when resected as a solitary pulmonary nodule is relatively good, whereas the prognosis of the large and disseminated lesions is very poor.

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Fig.1

PA (a), lateral (b) chest radiographs and high resolution CT (c) in a patient presenting with abundant mucoid sputum show lobar consolidation and air bronchogram within the anterior segment of the right upper lobe. Bronchoalveolar lavage provided the diagnosis of bronchioloalveolar cell carcinoma.
Bronchioalveolar cell carcinomatosis, Fig.1 (a)
Bronchioalveolar cell carcinomatosis, Fig.1 (b)
Bronchioalveolar cell carcinomatosis, Fig.1 (c)
Bronchioalveolar cell carcinomatosis, Fig.2 (a)
Bronchioalveolar cell carcinomatosis, Fig.2 (b)