CTICasesLymphangitic Carcinomatosis (Esophageal Adenocarcinoma)
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Imaging findings
Initial chest radiograph showed diffuse septal thickening, misinterpreted as pulmonary edema, but without effusions or cardiomegaly, and with a subtle obscuring of the descending aortic contour. A later radiograph showed worsening septal thickening and small nodules. CT revealed diffuse smooth septal thickening, pronounced bronchial wall thickening/cuffing, mass effect on airways, and narrowing of the inferior pulmonary vein, all associated with a huge central esophageal mass. Some lumpiness along the left major fissure was noted.
Key takeaways
Lymphangitic carcinomatosis primarily results from obstruction of lymphatics by tumor cells, leading to interstitial lung edema. Progressive worsening reflects increasing lymphatic obstruction. Disproportionately severe bronchial wall thickening/cuffing can help differentiate it from pure edema. Lumps along the septa suggest actual tumor nodules. Esophageal adenocarcinoma was the primary.
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