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Weekly Chest CasesArchive of Old Cases

Case No : 132 Date 2000-05-06

  • Courtesy of Yun-Hyeon Kim, M.D. / Chonnam University Hospital, Kwangju, Korea
  • Age/Sex 61 / F
  • Chief Complaintcough and sputum for two weeks, no fever or chillness
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Bronchioloalveolar carcinoma, multicentric or diffuse pattern
Radiologic Findings
Chest radiograph shows multiple poorly-defined nodular opacities in both lungs with predominant distribution in peripheral and lower lung zones.

Chest CT scans show multiple nodules and consolidations with or without a halo of ground-glass attenuation in the both peripheral lungs. CT-angiogram sign is seen in the consolidations of both lower lobes.
Brief Review
Bronchioloalveolar carcinoma can be defined as a peripheral, well-differentiated neoplasm, with a tendency to spread locally in the peripheral air space, using the lung structure as stroma.

Three types of this primary carcinoma of the lung have been recognized: a solitary nodule(43%), consolidation(30%), and multicentric or diffuse disease(27%).

A characteristic finding of bronchioloalveolar carcinoma is presence of bubble-like lucencies and pseudocavitation, which corresponds to patent small bronchi or air-containing cystic spaces in papillary tumors.

Mucin is of lower radiographic density than tumor, so it creates the areas of lower attenuation on mediastinal windows. The low attenuation allows vessels to be clearly seen, particularly after administration of IV contrast material. This finding, described as the CT angiogram sign, is suggestive but not specific for bronchioloalveolar carcinoma.

Multicentric or diffuse bronchioloalveolar carcinoma could be classified into three patterns: predominantly ground-glass, consolidative, and multinodular. Most patients with diffuse bronchioloalveolar carcinoma had a mixture of these findings.

Differential diagnosis of diffuse bronchioloalveolar carcinoma includes bronchogenic dissemination of tuberculosis, pneumonia in immunosuppressed patients, fungal infection, and hematogenous metastasis.
References
1. M Akira, S Atagi, M Kawahara, K Iuchi, and T Johkoh. High-resolution CT findings of diffuse bronchioloalveolar carcinoma in 38 patients. AJR 1999;173:1623-1629
2. B Adler, S Padley, RR Miller, and NL Muller. High-resolution CT of bronchioloalveolar carcinoma. AJR 1992;159:275-277
3. G Michele, B Mario, C Rosario, et al. CT-pathologic correlation in nodular bronchioloalveolar carcinoma. JCAT 1994;18(2): 229-232
Keywords
Lung, Malignant tumor, Bronchioloalveolar carcinoma, multicentric or diffuse pattern

No. of Applicants : 55

▶ Correct Answer : 45/55,  81.8%
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  • - Dr. Jankharia's Imaging Centre Bhavin Jankharia
  • - Gachon Medical School Gil Medical Center Seo Joon Beom
  • - Gospel Hospital, Kosin Medical College Hyunchul Kim
  • - Matsuyama Red Cross Hospital, Matsuyama, Japan Shunya Sunami
  • - NANVATI HOSPITAL-INDIA Bharat Gala
  • - Samsung Medical Center Kyung Soo Lee
  • - Seoul National University Hospital Seong Ho Park
  • - Soonchunhyan Hospital Lee Yong Bo
  • - Stedelijk OLV Ziekenhuis Mechelen, Belgium Ivan Pilate
  • - Hospital de Guipuzcoa / San Sebastian / Spain Gonzalo Vega - Hazas Porrua
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