SHM Converge Scientific Abstract ePoster Gallery-Pulmonary Lymphangitic Carcinomatosis: Rare Complication of Non-Small Cell Lung Cancer

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This case report describes pulmonary lymphangitic carcinomatosis (PLC), a rare and often terminal complication of advanced non-small cell lung cancer (NSCLC). The patient was a 72-year-old man with a smoking history who presented with four months of progressive dry cough, weight loss, night sweats, and worsening dyspnea. Initial evaluation showed elevated D-dimer, diminished breath sounds, bilateral pleural effusions, and pulmonary emboli. CT imaging demonstrated septal thickening, diffuse ground-glass opacities, and right upper lobe nodular consolidation.<br /><br />He was initially diagnosed with stage IV NSCLC after thoracentesis revealed malignant epithelial cells and PET/CT showed widespread metastatic disease involving lymph nodes, bone, lungs, and the left adrenal gland. He was discharged on apixaban and referred for oncology follow-up, but he rapidly worsened. A repeat CT scan later showed new diffuse interstitial opacities consistent with PLC. Because of his decline, he was not eligible for systemic cancer therapy and died three weeks after the initial cancer diagnosis.<br /><br />The report emphasizes that PLC often presents with nonspecific respiratory symptoms such as dyspnea and dry cough, making diagnosis difficult, especially when malignancy is not yet known. Imaging clues, particularly peribronchovascular thickening and interlobular septal thickening on CT, are important for early recognition. These findings may be subtle and can be mistaken for pulmonary edema or atypical infection.<br /><br />Key takeaways are that clinicians should maintain a high index of suspicion for PLC in patients with advanced NSCLC and compatible imaging findings. Earlier recognition may allow faster diagnostic workup, timely treatment discussions, and earlier goals-of-care conversations given the very poor prognosis once PLC develops.

Asset Subtitle

Prashant Patel

Meta Tag

Author List Khuzaima Rangwalla, Prashant Patel

Category Clinical Vignettes

Concept Pulmonary Lymphangitic Carcinomatosis

Concept Prognosis

Concept Interlobular Septal Thickening

Concept Malignancy

Concept Non-Small Cell Lung Cancer

Distinguished Non-Finalist

Presenter Organization Univeristy of California, San Francisco

Presenting Author Prashant Patel

Track Adult

Keywords

pulmonary lymphangitic carcinomatosis

non-small cell lung cancer

dyspnea

dry cough

interlobular septal thickening

ground-glass opacities

pleural effusion

metastatic disease

CT imaging

poor prognosis

Pulmonary Lymphangitic Carcinomatosis

Prognosis

Interlobular Septal Thickening

Malignancy

Non-Small Cell Lung Cancer