CTICasesDiffuse Lymphatic Congestion/Deposition (Etiology Pending)
Imaging findings
Initial CT showed pneumonia and a residual fluid collection. A follow-up study two months later shows diffuse, circumferential, lumpy-bumpy fluid attenuation involving the mediastinal and peripheral pleural surfaces. There is also extensive peribronchial cuffing, thicker than simple edema, suggesting congestion along the bronchovascular bundles. Areas of consolidation in the upper lobes have worsened, and new bilateral pleural effusions are present. All findings measure near zero Hounsfield units, consistent with fluid.
Key takeaways
Diffuse, progressive, lumpy-bumpy pleural and peribronchovascular thickening with fluid attenuation and hypoxemia, unresponsive to diuresis, strongly suggests a lymphatic process. The differential includes lymphatic carcinomatosis, lymphoproliferative disorder (e.g., lymphoma), amyloidosis, or potentially a chylothorax. Histopathology (e.g., via transbronchial biopsy) is crucial for definitive diagnosis in such challenging cases.
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