Pulmonary Lymphangitis Carcinomatosa Secondary to Breast Carcinoma – A Case Report

Abstract

Pulmonary lymphangitis carcinomatosa (PLC) is a distinctive pattern of metastatic spread through the pulmonary lymphatic channels and is commonly associated with breast carcinoma. We present a case highlighting characteristic breast and lung imaging findings emphasizing the radiologist’s role in early diagnosis.

Lymphangitis carcinomatosa accounts for a minority of pulmonary metastases but carries significant prognostic implications.^[1] Breast carcinoma is among the most frequent primary malignancies associated with this condition. Tumour infiltration of pulmonary lymphatic channels leads to characteristic interstitial lung changes, often mimicking pulmonary edema or interstitial lung disease.^[2] The 40-49 years age group is most commonly affected.^[3] In 46% of patients respiratory symptoms are the initial presentation of the underlying carcinoma. The most common underlying primary tumours are breast (33%), stomach (29%) and lung cancers (17%). Approximately 50% die within 3 months of their first respiratory symptoms, but those with a primary prostatic carcinoma may have good remission with adjuvant hormonal therapy.

Clinical, radiographic, and physiological features of drug-induced and radiation-induced pulmonary injury are often difficult to distinguish from other causes of pulmonary infiltrates (e.g., infections, pulmonary edema, alveolar hemorrhage, etc.).^[4] Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) is essential to exclude infectious etiologies. In some cases, surgical lung biopsies are required to establish a specific etiological diagnosis.