CTICasesLymphatic Spread of Adenocarcinoma Mimicking Post-Radiation Changes
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Imaging findings
A patient with lung cancer (adenocarcinoma) has a mass in the medial right lower lobe with traction bronchiectasis, some volume loss, and ground glass opacity. Initial studies showed a larger mass, bulky mediastinal/hilar adenopathy, and more extensive ground glass opacities with nodules. The radiation therapy was completed long before the more recent scan.
Key takeaways
Distinguishing lymphatic spread of adenocarcinoma from post-radiation pneumonitis and fibrosis is crucial. When radiation therapy was completed years prior, new or progressing ground glass opacity with nodules, or changes in extent, should raise suspicion for recurrent malignancy with lymphatic spread rather than stable or resolving post-radiation changes, which should have stabilized by then. The time course of radiation completion is critical for accurate assessment.
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