THE COMPLEX DIFFERENTIAL-DIAGNOSIS OF DIF FUSE MICRONODULAR PULMONARY-INFILTRATES

We report the case of a 36-year-old, previously healthy male patient p resenting with progressive shortness of breath and dry cough. Chest X- ray revealed a diffuse micronodular interstitial pattern and pulmonary function tests showed reduced diffusion capacity, a restrictive patte rn and obstructive airflow limitation. Transbronchial biopsy disclosed lymphangiosis carcinomatosa. The primary tumor was adenocarcinoma of the stomach. Differential diagnosis and the diagnostic approach to int erstitial lung diseases are discussed. History, clinical findings, rad iological and functional tests, as well as blood chemistry serve to na rrow down the differential diagnosis. The main further investigative s teps are bronchoscopy with broncho-alveolar lavage and transbronchial biopsies, high resolution computer tomography, and thoracoscopic biops y.