The ‘Fragmented’ Scintigraphic Lung Pattern in Pulmonary Lymphangitic Carcinomatosis Secondary to Breast Cancer

Abstract

Pulmonary lymphangitic carcinomatosis (PLC) is an unusual presentation of diffuse infiltrative lung disease. In this report we present two cases secondary to breast cancer; the diagnosis was made by means of transbronchial lung biopsy or postmortem examination. The goal of this study was to analyze the scintigraphic pattern of pulmonary perfusion performed with technetium-99m macroaggregated albumin (^99mTc-MAA) in the hope of achieving improved recognition of PLC and its subsequent diagnosis. Upon admission, both patients underwent routine clinical exams followed by chest X-rays. The second patient also underwent CT examination, and both were ultimately examined using pulmonary perfusion scintigraphy with ^99mTc-MAA. In the various exams performed, the most reliable and easily identified diagnostic finding turned out to be a characteristic ‘fragmented’ lung pattern revealed with the perfusion lung scan. Unfortunately, in both cases the patients’ conditions rapidly worsened and death occurred shortly following scintigraphy. We were able to conclude that the recognition of the mentioned fragmented scintigraphic lung pattern may be useful in suspected PLC, whereas the nonspecific clinical presentation of this pathology makes diagnosis extremely difficult, with the most significant results being achieved through a comparison of scintigraphic and high resolution CT data.

Unilateral Nodular and Interstitial Infiltrate in a 71-Year-Old Man

“…Given the low resistance of these channels, the spread is rapid. Eighty percent of reported cases of LC are adenocarcinomas, usually arising from sites such as the lung, pancreas, breast, and stomach [7][8][9] . The carcinoma spread can cause patients to present with dyspnea or fatigue.…”

Pulmonary lymphangitic sarcomatosis and a review of the literature

“…It was first described by Gabriel Andal in 1829 in connection with a woman who had died as a result of carcinoma of the uterus [3]. On the other hand, lymphangitic spreading of a sarcoma, presenting as a diffusely infiltrative lung disease, is extremely rare.…”