0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

The Term "Lymphangitic Pulmonary Metastases" Resurrected

Leonard Sadoff, MD
Arch Intern Med. 1999;159(11):1254. doi:.
Text Size: A A A
Published online

Extract

In the January 12, 1998, issue of the ARCHIVES, "Autopsy and Medicine" Case of the Month series1 and the subsequent letter "Pulmonary Arterial Carcinomatosis vs Pulmonary Embolism" by Dr Johnson,2 the discussion appears incomplete to me. The well-known disease entity formerly known as lymphangitic pulmonary metastases (LPM) (which seems to have disappeared from most text books) was and continues to be characterized clinically by severe respiratory insufficiency with hypoxemia, pathologically by widespread lymphatic metastases, and radiologically by bilateral reticular infiltrates. In 1971, Janower and Blennerhassett3 showed that patients with LPM had tumor emboli in the pulmonary arterial vasculature, which was probably responsible for the severe physiological abnormalities present in this condition. They suggested the LPM—commonly associated with reticular infiltrates on chest films—occurs secondary to tumor embolization. Pulmonary arterial carcinomatosis microemboli (PACME) leads sequentially to LPM. Chest x-ray films may not show abnormalities in the former and abnormalities in the latter. We showed this in a report over 20 years ago.4 We also pointed out that like ordinary pulmonary embolism, LPM—or more specifically, its precursor, PACME—could be associated with abnormalities seen on perfusion lung scans in the face of normal chest radiographs.4 Ventilation-perfusion lung scanning can be a powerful tool in PACME, whereas high-resolution computed tomographic lung scanning is very useful in LPM to detect early linear-reticular infiltrates. Failure to appreciate the important research by Janower and Blennerhassett,3 ie, the evolving of LPM from PACME, may cause considerable confusion for internists, oncologists, pathologists, and radiologists (as well as those involved in medical nomenclature).

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
brightcove.createExperiences();