Lobar bronchioloalveolar carcinoma: "angiogram sign" on CT scans

The authors reviewed computed tomographic (CT) scans of 12 patients with lobar bronchioloalveolar carcinoma. Seven patients had consolidation of the entire lobe, and five patients had segmental consolidation. After contrast material was administered intravenously, the consolidated lung typically appeared on the scan as an area of homogeneous low attenuation, within which were enhanced branching pulmonary vessels (the CT angiogram sign). To evaluate the specificity of this sign in the discrimination of bronchioloalveolar carcinoma, CT scans of 26 patients who had lobar consolidation from other diseases were randomly mixed with the CT scans of 11 patients with bronchioloalveolar carcinoma. Two independent observers who were unfamiliar with the cases classified 10 and nine of the 11 patients with bronchioloalveolar carcinoma, respectively, as positive for bronchioloalveolar carcinoma by applying the CT angiogram sign, and classified as negative 25 and 23 of the 26 patients without bronchioloalveolar carcinoma, respectively, for an overall specificity of 92.3%. The angiogram sign appeared on the CT scan because of the low-attenuating consolidation, which was caused by the production of mucin or other fluid and the intact bronchovascular framework within the tumor.