Chest Imaging

Lymphangitic carcinomatosis

tumour growth in the lymphatic system of the lungs. It occurs most commonly in patients with carcinomas of the breast, lung, stomach, pancreas, prostate, cervix or thyroid, and in patients with metastatic adenocarcinoma from an unknown primary site. It usually results from haematogenous spread to lung, with subsequent interstitial and lymphatic invasion, but can also occur because of direct lymphatic spread of tumour from mediastinal and hilar lymph nodes. Symptoms of shortness of breath are common and can predate radiographic abnormalities.

The radiographic manifestations of pulmonary lymphangitic carcinomatosis include reticular opacities, Kerley lines, hilar and mediastinal lymphadenopathy and pleural effusion. However, these findings are nonspecific.

Tumour growth in the peribronchovascular and septal lymphatics located within these compartments, and associated oedema, result in the characteristic HRCT findings of lymphangitic carcinoma. Lymphangitic carcinomatosis is characterized on HRCT by reticular opacities. Specific findings include:

  • thickening of the peribronchovascular interstitium surrounding vessels and bronchi in the parahilar lung;

  • interlobular septal thickening (Fig.1 a,b) and subpleural interstitial thickening that is smooth, or nodular;

  • thickening of the peribronchovascular axial interstitium in the centrilobular regions; and

  • a preservation of normal lung architecture at the lobular level, despite the presence of these findings.

    Hilar lymphadenopathy is visible on CT in only 50% of patients with lymphangitic carcinoma. Lymph node enlargement can be symmetrical or asymmetrical. pleural effusion may also be present.

    RW

    • To view high resolution images,
    please register first.

    Click  here to register.

    Already registered? Enter your e-mail in the window below.
    Re-register

    Fig.1

    a, b. HRCT scans in a patient with lymphangitic spread of breast cancer. Interlobular septal thickening in the right lung is the predominant abnormality.
    Lymphangitic carcinomatosis, Fig.1 (a)
    Lymphangitic carcinomatosis, Fig.1 (b)