대한흉부영상의학회 Weekly Chest Cases

Courtesy of Cherry Kim / Korea University Ansan Hospital
Age/Sex 46 / M
Chief ComplaintDyspnea, Shortness of breath; Occupational history of aluminum chassis manufacturing for 6 months, management in the same industry for 19 years

Diagnosis: Adenocarcinoma
Radiologic Findings: Fig 1. Chest PA shows ill-defined haziness in right lower lung zone
Fig 2-3. CT scans reveals diffuse ill-defined centrilobular GGO in RML and BLLs. Patchy GGO with emphysema in RML.
Brief Review: Lung adenocarcinoma can sometimes mimic diffuse inflammatory interstitial lung disease, leading to delayed diagnosis. This phenomenon, known as pneumonic-type adenocarcinoma or diffuse pulmonary adenocarcinoma, presents with ground-glass opacities (GGOs), interstitial thickening, and fibrosis-like changes on imaging, resembling ILD.

Clinical Features
Progressive dyspnea and non-productive cough, similar to ILD
Diffuse lung infiltrates on imaging rather than a discrete mass
Minimal or absent hemoptysis (unlike classic lung cancer)
Poor response to steroids or immunosuppressants, raising suspicion of malignancy

Radiological Findings
Diffuse GGOs, reticulations, or consolidation, mimicking ILD patterns (e.g., NSIP, COP)
Crazy paving pattern (seen in mucinous adenocarcinoma)
Multiple nodular opacities or infiltrates
May show traction bronchiectasis or honeycombing, mimicking pulmonary fibrosis
References: Mehta A, Bath A, Gadre A, Schauer M. Lung adenocarcinoma presenting as interstitial lung disease. BMJ Case Rep. 2020 Aug 18;13(8):e235602.
Keywords

대한흉부영상의학회 Korean Society of Thoracic Radiology