Case 55

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
The patient was a 15 year old female who at the age of 12 years old had cysts incidentally noted in her lungs on a chest film. One month ago, she developed symptoms including a dry, non-productive cough. The patient did not have a history of foreign travel or a history of unusual exposures.

Clinical Physical Exam:
Unremarkable

Clinical Labs:
A sweat test was negative.

Clinical Differential Diagnosis:
Papillomatosis

Imaging Findings:
A chest film demonstrated multiple, variably sized cystic lesions in both lungs. These were better characterized on a chest CT exam. Abdomen CT exam (not provided) was unremarkable.

Images 1 and 2

Images 3 and 4

Imaging Differential Diagnosis:
Fungal / granulomatous / indolent bacterial infection, atypical metastatic disease, cystic fibrosis, eosinophilic granuloma.

Operative Findings:
A bronchoscopy was performed and failed to reveal any papillomas in the airways. An open lung biopsy was then performed.

Pathological Findings:
Pathological examination of the surgical specimen revealed the presence of bronchoalveolar carcinoma.

Final Diagnosis:
Bronchoalveolar Carcinoma

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. It was decided not to treat the patient until she became severely symptomatic as the tumor is usually slow growing and the chemotherapeutic agent is quite toxic.

Similar Cases:
None

References:

• International Thoracic Teaching Resource - http://www.vh.org/adult/provider/radiology/ITTR/BronchAlvCar/BronchAlvCar.html
• WebPath
• WebPath

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