CTICasesDiffuse Multifocal Pulmonary Adenocarcinoma with Lepidic Growth
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Imaging findings
Initial chest radiographs and CT demonstrate subtle, poorly marginated, and ill-defined ground-glass opacities in the right upper lobe. Serial imaging over several months reveals progression to extensive bilateral consolidation, ground-glass opacities, and nodules. Positron emission tomography (PET) shows intense FDG avidity within the largest regions of consolidation, and biopsy confirms adenocarcinoma with a predominant lepidic growth pattern.
Key takeaways
Multifocal pulmonary adenocarcinoma with a lepidic growth pattern (formerly known as bronchioloalveolar carcinoma) can mimic non-malignant processes, particularly infectious pneumonia, organizing pneumonia, or diffuse alveolar hemorrhage. The presence of persistent, progressive, and FDG-avid consolidations that fail to respond to standard medical therapies should prompt a high index of suspicion for malignancy, necessitating a biopsy even if diagnostic procedures like bronchoalveolar lavage suggest other etiologies.
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