A Rare Etiology of Cystic Lung Disease

Metastases presenting in the form of cystic lung disease are a very rare occurrence. Even rarer is the association of such metastases with primary pancreatic carcinoma. Here we have described the case of a 60-year-old man who presented with a six-month history of worsening shortness of breath and dry cough associated with loss of weight and appetite. At the time of admission, his oxygen saturation on room air was found to be 82% and the respiratory rate was 28/minute. Apart from bilateral diffuse coarse crackles, the rest of the physical examination was largely unremarkable. All his blood tests were found to be normal except for raised levels of alkaline phosphatase (268 IU/L). The levels of cancer antigen (CA) 19-9 were also found to be elevated (238.8 IU/ml). CT of the chest and abdomen revealed the presence of multiple cystic lesions with predominance in the lower lobes of the lungs and an enlarged head of pancreas. The patient underwent side-view esophagogastroduodenoscopy and multiple biopsies taken from the lesion in the head of pancreas revealed the presence of multiple atypical cells with glandular formation suggestive of adenocarcinoma. We were not able to directly demonstrate the tumor cells in lung tissue, as the patient was not fit for bronchoscopic procedures due to high oxygen requirements. However, the temporal course of the development of symptoms, and cysts do correlate suggesting metastasis as the etiology of cystic lesions found in his lung.