Lymphangitic Carcinomatosis

Progressive hypoxaemic respiratory failure due to inflammation and obstruction of pulmonary lymphatics secondary to infiltration of malignant cells.

Lymphangitic carcinomatosis is distinct from (but related to) pulmonary tumour embolism, which occurs due to haematogenous embolism of tumour cells into pulmonary vasculature and leads to greater pulmonary hypertension and right heart failure.

Epidemiology and Risk Factors

Pathophysiology

Aetiology

Assessment

Days to weeks history of:

Progressive dyspnoea
Pleuritic chest pain
Cough
Haemoptysis
Weight loss
Fever
Tachypnoea

History

Common primary malignancies include:

Patients will usually have a diagnosed malignancy, although on rare occasions lymphangitic carcinomatosis may be the primary presentation.

Breast
Lung
Gastric
Prostate
Pancreatic
Colon
Cervical
Uterine

Examination

Investigations

Bedside:

Laboratory:

Imaging:

CXR
Normal in 30-50% in early stages, however may demonstrate:
- Interstitial oedema
- Pleural effusions
CT chest
- Interstitial oedema
- Thickening of interlobular septa
- Preservation of lung architecture
PET C Highly sensitive.

Other:

Diagnostic Approach and DDx

Management

Treat underlying malignancy
Oxygen
Consider mechanical ventilation
Depending on prognosis.
Consider steroids

Resuscitation:

Specific therapy:

Pharmacological
Procedural
Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

Prognosis

Typically indicates end-stage malignancy, with survival estimates ~6 months

Key Studies

References

Ak AK, Mantri SN. Lymphangitic Carcinomatosis. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Dec 29].