An unusual cause for diffuse pulmonary nodules

Description

We present the case of a 67-year-old woman with a 3-week history of dysphagia in the absence of any respiratory or constitutional symptoms. A lifelong non-smoker with no significant medical comorbidities, it was thought unusual that a routine chest radiograph (figure 1) demonstrated diffuse, small, irregular nodules throughout her lung fields. The diagnosis of primary lung adenocarcinoma was made on the basis of a CT-guided biopsy (figure 2). It is likely that this atypical presentation and radiological appearance of primary malignancy is related to the erosion of tumour into one of the pulmonary arteries thus disseminating the neoplasm throughout the lungs. The cause for the patient's symptoms was attributed to malignant involvement of the central nervous system.

Figure 1

Chest X-ray.

Figure 2

CT scan of the chest.

To distinguish between...

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