CTICasesSecond Mucinous Adenocarcinoma Mimicking Interstitial Lung Disease
Imaging findings
A 70-year-old with shortness of breath and suspected interstitial lung disease has CT showing faint ground-glass opacities together with a crazy-paving pattern and traction bronchiectasis predominantly in the right lower lobe, more pronounced than on the left. Follow-up imaging months later after a course of antibiotics shows persistence of the abnormality with additional new ground-glass opacities in other lobes, including the contralateral lung.
Key takeaways
Crazy-paving with traction bronchiectasis that persists despite antibiotics and later develops contralateral spread represents mucinous adenocarcinoma with aerogenous spread rather than usual interstitial pneumonia or organizing pneumonia; new contralateral disease upgrades staging and should prompt biopsy rather than continued treatment for a presumed interstitial process.
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