CTICasesPulmonary Lymphangitic Carcinomatosis from Gastric Cancer
Imaging findings
PET/CT shows an extensive metastatic burden with FDG-avid osseous and upper abdominal lymph nodes, including nodes adjacent to the stomach, along with an FDG-avid gastroesophageal junction mass subsequently confirmed as gastric cancer on endoscopic biopsy. In the chest, there is florid diffuse interstitial thickening with septal lines, peribronchial fluid cuffing, and pleural effusion, out of proportion to any cardiac abnormality, together with shaggy, irregular-appearing pulmonary veins from lymphatic engorgement and corresponding diffuse pulmonary FDG activity.
Key takeaways
Despite an initial clinical impression of pulmonary edema, the imaging pattern of florid interstitial thickening with septal lines and peribronchial cuffing, together with diffuse pulmonary FDG uptake and shaggy pulmonary veins, was considered diagnostic of pulmonary lymphangitic tumor spread from the known gastric primary without the need for additional lung biopsy.
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