Korean Society of Thoracic Radiology
The Korean Radiological Society
FINDINGS
Initial chest radiograph shows homogenous air-space
consolidation with air-bronchogram in the right upper lung zone and multiple
small nodular opacities in the both lung fields. Follow-up chest radiograph
shows increased extent of air-space consolidation. CT scans reveals that
there is no obstructive lesion in the right upper lobe bronchus. The consolidation
is present in the right upper lobe and right middle lobe. There are also
numerous patchy and nodular lesions, some of which have internal air densities.
The patient expectorated large amount of sputum upto one litter per day,
which was mucoid in nature with bubble-like appearance, so called a feature
of bronchorrhea. The diagnosis was confirmed by bronchoscopy with BAL and
cytologic examination.
DISCUSSION
Bronchioloalveolar carcinoma represents 1.5%-6.5%
of all primary pulmonary neoplasms (1). Bronchorrhea (white mucoid or watery
expectoration) is unusual and a late manifestation. Bronchioloalveolar
carcinoma tends to spread through the airways, but lymphogenous and hematogenous
dissemination may occur in 50%-60% of cases (2). Bronchioloalveolar carcinoma
appears radiographically as a single nodule, segmental or lobar consolidation,
or diffuse nodules (3). The lobar consolidative form may demonstrate the
CT angiogram and open bronchus signs. The diffuse nodular form appears
as multiple nodules or areas of ground-glass atteunuation or consolidation.
Bubblelike areas of low attenuation (pseudocavitation)
are observed more frequently with bronchioloalveolar carcinoma (50% of
cases) than with other malignant lesions (4). Bubblelike areas of low attenuation
within the lesion are due to patent small airways within the nodule or
distended alveolar spaces within papillary regions of tumor ingrowth. Because
the tumor proliferates along the walls of the alveolus without disrupting
the overall lung architecture, pseudocavitation may also occur when bronchioloalveolar
carcinoma develops adjacent to an area of preexisting cystic change.
The multinocular form (seen radiographically in 27% of cases) manifests
as multiple, bilateral, well-circumscribed nodules on radiographs. The
CT appearances of multinodular bronchioloalveolar carcinoma are diverse
and include poorly or well-defined nodules, multiple cavitary nodules,
and multiple poorly defined areas of ground-glass attenuation or consolidation
(5).
REFERENCES
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of bronchioloalveolar lung carcinoma and its unique clinicopathologic features.
Cancer 1994; 73: 1163-1170
2. Greenberg SD, Smith MN, Spjut HJ. Bronchioloalveolar carcinoma:
cell of origin. Am J Clin Pathol 1975; 63:153-167
3. Lee KS, Kim Y, Han J, Ko EJ, Park CK, Primack SL. Bronchioloalveolar
carcinoma: clinical, histopathologic, and radiologic findings. Radiographics
1997; 17: 1345-1357
4. Zwirewich CV, Vedal S, Miller RR, Muller NL. Solitary pulmonary
nodule: high-resolution CT and radiographic-pathologic correlation. Radiology
1991; 179: 469-476
5. Zwirewich CV, Miller RR, Muller NL. Multicentric adenocarcinoma
of the lung: CT-pathologic correlation. Radiology 1990; 176: 185-190