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Occult pulmonary lymphangitic carcinomatosis presenting as 'chronic cough' with a normal HRCT chest.

Jinnur PK, Pannu BS, Boland JM, Iyer VN - Ann Med Surg (Lond) (2016)

Bottom Line: He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation.A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary.Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.

ABSTRACT
A diagnosis of 'chronic cough' (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of 'chronic cough' and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported.

No MeSH data available.


Related in: MedlinePlus

Follow up CT Chest 4 months after baseline CT.
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fig3: Follow up CT Chest 4 months after baseline CT.

Mentions: Based on the above test results, a treatment regimen consisting of twice daily proton pump inhibitor therapy for GERD and concurrent treatment for PND was undertaken. Several weeks of this regimen resulted in no symptom improvement. A bronchoscopy with random bronchial mucosal biopsies showed chronic inflammation without evidence for infection or malignancy. During a subsequent follow-up visit 5 weeks after the initial consultation, the patient reported new onset weight loss, decreased appetite, and a worsening cough. A repeat HRCT chest (Fig.3) was then obtained and showed interval development of diffuse pulmonary nodules along with interlobar septal thickening throughout both lungs suggestive of a diffuse hematogenous and lymphangitic metastatic process. New mild bilateral hilar adenopathy was noted without any dominant pulmonary lesion. PET scan revealed intense FDG uptake in the mesenteric wall of the ascending colon with associated wall thickening suggestive of a colon primary. In addition, extensive metastatic disease was noted with FDG avid lesions in multiple lymph nodes in the lower neck, retroperitoneum, skeleton, liver and both lung fields.


Occult pulmonary lymphangitic carcinomatosis presenting as 'chronic cough' with a normal HRCT chest.

Jinnur PK, Pannu BS, Boland JM, Iyer VN - Ann Med Surg (Lond) (2016)

Follow up CT Chest 4 months after baseline CT.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4764654&req=5

fig3: Follow up CT Chest 4 months after baseline CT.
Mentions: Based on the above test results, a treatment regimen consisting of twice daily proton pump inhibitor therapy for GERD and concurrent treatment for PND was undertaken. Several weeks of this regimen resulted in no symptom improvement. A bronchoscopy with random bronchial mucosal biopsies showed chronic inflammation without evidence for infection or malignancy. During a subsequent follow-up visit 5 weeks after the initial consultation, the patient reported new onset weight loss, decreased appetite, and a worsening cough. A repeat HRCT chest (Fig.3) was then obtained and showed interval development of diffuse pulmonary nodules along with interlobar septal thickening throughout both lungs suggestive of a diffuse hematogenous and lymphangitic metastatic process. New mild bilateral hilar adenopathy was noted without any dominant pulmonary lesion. PET scan revealed intense FDG uptake in the mesenteric wall of the ascending colon with associated wall thickening suggestive of a colon primary. In addition, extensive metastatic disease was noted with FDG avid lesions in multiple lymph nodes in the lower neck, retroperitoneum, skeleton, liver and both lung fields.

Bottom Line: He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation.A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary.Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution.

View Article: PubMed Central - PubMed

Affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.

ABSTRACT
A diagnosis of 'chronic cough' (CC) requires the exclusion of sinister pulmonary pathology, including infection and malignancy. We present a patient with a 3 month history of CC who had an extensive workup including a normal high resolution computed tomography of the chest (HRCT) 6 weeks prior to consultation at our center. He subsequently developed constitutional symptoms including weight loss and loss of appetite 5 weeks after initial consultation. A repeat HRCT chest and a subsequent whole body PET scan found that he had developed extensive pulmonary lymphangitic carcinomatosis (PLC) from a colon primary. Treatment of the colon cancer resulted in significant decrease in metastatic disease burden and cough resolution. PLC is a very rare cause of 'chronic cough' and incipient/occult PLC presenting with chronic cough and a normal initial HRCT chest has not been previously reported.

No MeSH data available.


Related in: MedlinePlus