Images in Clinical Medicine

Bronchoalveolar-Cell Carcinoma

Richard Booton, M.R.C.P., and B.K. Jacob, F.R.C.P.

N Engl J Med 2002; 346:107January 10, 2002

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Figure 1 A 45-year-old woman with a history of cigarette smoking presented with pneumonia. A chest radiograph confirmed the presence of consolidation of the right upper lung. Her symptoms resolved with antibiotic therapy, and she had normal findings on fiberoptic bronchoscopy. Subsequent chest radiography demonstrated slowly resolving, confluent opacities in the right and left lung fields (Panel A). A high-resolution computed tomographic scan of the thorax confirmed the presence of widespread, dense consolidation in the right upper lobe (Panel B), with smaller areas of peribronchovascular subsegmental consolidation throughout both lung fields. A transbronchial biopsy led to the diagnosis of bronchoalveolar-cell carcinoma. The patient died after 10 months of palliative care.

The presence of nonresolving pneumonia in a smoker prompts consideration of a proximal obstructing tumor. However, several forms of non–small-cell lung cancer, including bronchoalveolar-cell carcinoma, occur more commonly in nonsmokers. Bronchoalveolar-cell carcinoma is a very uncommon variant of adenocarcinoma that is most frequently seen peripherally on chest radiographs, beyond the limits of bronchoscopic inspection, as a nodule, mass, or pneumonia-like infiltrate. It can spread through the trachea to the other hemithorax.

Richard Booton, M.R.C.P.
Christie National Health Service Trust, Manchester M20 4BX, United Kingdom

B.K. Jacob, F.R.C.P.
Bradford National Health Service Trust, Bradford BD9 6RJ, United Kingdom

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