THE FRAGMENTED SCINTIGRAPHIC LUNG PATTERN IN PULMONARY LYMPHANGITIC CARCINOMATOSIS SECONDARY TO BREAST-CANCER

Pulmonary lymphangitic carcinomatosis (PLC) is an unusual presentation of diffuse Infiltrative lung disease. In this report we present two c ases secondary to breast cancer; the diagnosis was made by means of tr ansbronchial lung biopsy or postmortem examination. The goal of this s tudy was to analyze the scintigraphic pattern of pulmonary perfusion p erformed with technetium-99m macroaggregated albumin (Tc-99m-MAA) in t he hope of achieving improved recognition of PLC and its subsequent di agnosis. Upon admission, both patients underwent routine clinical exam s followed by chest X-rays. The second patient also underwent CT exami nation, and both were ultimately examined using pulmonary perfusion sc intigraphy with Tc-99m-MAA. In the various exams performed, the most r eliable and easily identified diagnostic finding turned out to be a ch aracteristic 'fragmented' lung pattern revealed with the perfusion lun g scan. Unfortunately, in both cases the patients' conditions rapidly worsened and death occurred shortly following scintigraphy. We were ab le to conclude that the recognition of the mentioned fragmented scinti graphic lung pattern may be useful in suspected PLC, whereas the nonsp ecific clinical presentation of this pathology makes diagnosis extreme ly difficult, with the most significant results being achieved through a comparison of scintigraphic and high resolution CT data.