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Colonic Lung Metastasis Presenting as Diffuse Alveolar Infiltrates
Lung Cancer SESSION TITLE: Fellow Case Report Poster - Lung Cancer SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM
Colonic Lung Metastasis Presenting as Diffuse Alveolar Infiltrates Anand Kumar Rai MBBS* Nidhi Aggarwal MBBS Rebecca Weiss MD; and Yizhak Kupfer MD Maimonides Medical Center, Brooklyn, NY INTRODUCTION: Metastatic disease to lung can present with a variety of appearances. We present a case of colonic metastasis to the lung that presented as diffuse infiltrates. CASE PRESENTATION: A 55 year old male presented to the E.R. complaining of shortness of breath and cough productive of yellow sputum with intermittent fever for 3 months. He was recently treated in another hospital for pneumonia. On presentation, he had fever of 102 F, tachycardia, tachypnea and severe hypoxia requiring a high FiO2. Chest X-ray showed bilateral diffuse fluffy infiltrates. CT chest showed bilateral airspace densities with areas of confluent consolidation, interlobular septal thickening, hilar lymphadenopathy and bilateral pleural effusions, consistent with atypical pneumonia. He was admitted to the ICU for acute respiratory failure due to suspected HCAP and treated with antibiotics. Further investigation revealed a recent diagnosis of poorly differentiated adenocarcinoma of the sigmoid colon. A VATS with pulmonary wedge biopsy revealed metastatic adenocarcinoma of gastrointestinal phenotype with positive KRAS mutation. He was started on FOLFOX based chemotherapy. CT scan 4 months later showed marked improvement of the airspace disease and resolution of mediastinal lymphadenopathy. DISCUSSION: Pulmonary nodules and masses are the most common manifestations of lung metastasis. The most commonly reported atypical radiologic features of metastases include cavitation, calcification, pneumothorax, air-space pattern, tumor embolism, endobronchial metastasis, dilated vessels within a mass1. Most of these are however commonly seen in nonmalignant diseases. A retrospective analysis looking at known cases of lung metastases found that only 6 out of 65 patients with GI metastases to the lung showed air space disease on CT, and only 2 out of these 6 were due to metastatic colon carcinoma2. Thus CT findings in our patient are uncommon presentation of pulmonary metastases from colon cancer. CONCLUSIONS: Our case emphasizes the importance of obtaining a full clinical history and prior medical records. It also shows the importance of maintaining a broad differential diagnosis when evaluating patients with radiographic evidence of extensive lung pathology and the need for lung biopsy for definitive diagnosis.
Reference #2: Gaeta, M, Air-space pattern in lung metastasis from adenocarcinoma of the GI, J Comput Assist Tomogr. 1996 MarApr, 20(2):300-4 DISCLOSURE: The following authors have nothing to disclose: Anand Kumar Rai, Nidhi Aggarwal, Rebecca Weiss, Yizhak Kupfer No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.774
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
679A
LUNG CANCER
Reference #1: Joon Beom et al, Atypical Pulmonary Metastases: Spectrum of Radiologic Findings, Radiographics. 2001, 21(2):403-417
Colonic Lung Metastasis Presenting as Diffuse Alveolar Infiltrates Anand Kumar Rai MBBS* Nidhi Aggarwal MBBS Rebecca Weiss MD; and Yizhak Kupfer MD Maimonides Medical Center, Brooklyn, NY INTRODUCTION: Metastatic disease to lung can present with a variety of appearances. We present a case of colonic metastasis to the lung that presented as diffuse infiltrates. CASE PRESENTATION: A 55 year old male presented to the E.R. complaining of shortness of breath and cough productive of yellow sputum with intermittent fever for 3 months. He was recently treated in another hospital for pneumonia. On presentation, he had fever of 102 F, tachycardia, tachypnea and severe hypoxia requiring a high FiO2. Chest X-ray showed bilateral diffuse fluffy infiltrates. CT chest showed bilateral airspace densities with areas of confluent consolidation, interlobular septal thickening, hilar lymphadenopathy and bilateral pleural effusions, consistent with atypical pneumonia. He was admitted to the ICU for acute respiratory failure due to suspected HCAP and treated with antibiotics. Further investigation revealed a recent diagnosis of poorly differentiated adenocarcinoma of the sigmoid colon. A VATS with pulmonary wedge biopsy revealed metastatic adenocarcinoma of gastrointestinal phenotype with positive KRAS mutation. He was started on FOLFOX based chemotherapy. CT scan 4 months later showed marked improvement of the airspace disease and resolution of mediastinal lymphadenopathy. DISCUSSION: Pulmonary nodules and masses are the most common manifestations of lung metastasis. The most commonly reported atypical radiologic features of metastases include cavitation, calcification, pneumothorax, air-space pattern, tumor embolism, endobronchial metastasis, dilated vessels within a mass1. Most of these are however commonly seen in nonmalignant diseases. A retrospective analysis looking at known cases of lung metastases found that only 6 out of 65 patients with GI metastases to the lung showed air space disease on CT, and only 2 out of these 6 were due to metastatic colon carcinoma2. Thus CT findings in our patient are uncommon presentation of pulmonary metastases from colon cancer. CONCLUSIONS: Our case emphasizes the importance of obtaining a full clinical history and prior medical records. It also shows the importance of maintaining a broad differential diagnosis when evaluating patients with radiographic evidence of extensive lung pathology and the need for lung biopsy for definitive diagnosis.
Reference #2: Gaeta, M, Air-space pattern in lung metastasis from adenocarcinoma of the GI, J Comput Assist Tomogr. 1996 MarApr, 20(2):300-4 DISCLOSURE: The following authors have nothing to disclose: Anand Kumar Rai, Nidhi Aggarwal, Rebecca Weiss, Yizhak Kupfer No Product/Research Disclosure Information DOI:
http://dx.doi.org/10.1016/j.chest.2016.08.774
Copyright ª 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.
journal.publications.chestnet.org
679A
LUNG CANCER
Reference #1: Joon Beom et al, Atypical Pulmonary Metastases: Spectrum of Radiologic Findings, Radiographics. 2001, 21(2):403-417