Pulmonary lymphangitic carcinomatosis mimicking interstitial lung disease

Pulmonary Lymphangitic Carcinomatosis (PLC) is a rare and aggressive form of metastatic spread. Pathophysiologically, PLC occurs through secondary spread of tumor emboli to the pulmonary lymphatic system and further malignant infiltration of pulmonary interstitium. Radiologic findings may mimic alternative pulmonary pathology such as interstitial lung disease or infection leading to a delayed diagnosis. We describe a case of PLC in a patient with metastatic breast cancer and interesting, nonspecific computed tomography (CT) chest findings.

A middle-aged female presented with progressive dyspnea and non-productive cough. Thoracic CT showed diffuse patchy airspace consolidation with smooth interlobular septal thickening. Echocardiography and right heart catheterization revealed elevated right ventricular systolic pressure with normal pulmonary capillary wedge pressure. Despite empiric treatment for pneumonia, her hypoxia persisted. Bronchoscopy with biopsy identified a HER2-positive breast carcinoma with metastatic lymphangitic spread, consistent with PLC. The patient was initiated on palliative chemotherapy and eventually was referred to hospice 1 month after diagnosis.

Atypical CT findings of PLC sometimes may mimic interstitial lung disease. PLC is a rapidly progressive, aggressive disease due to the nature of its staging at diagnosis. This case highlights the importance of maintaining a high index of clinical suspicion and obtaining an early tissue biopsy to establish definitive diagnosis.