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Bilateral multiple cavities in bronchiolar carcinoma.

A 52 year old woman was admitted to hospital because of increasing cough and dyspnoea. Mild dyspnoea and a cough had developed two years earlier and subsequently increased in severity, with the production of copious whitish sputum. Twenty months before admission a chest radiograph showed homogeneous consolidation in the anterior segment of the right upper lobe (fig 1). Physical examination showed rhonchi in both lungs and anterior cervical and supraclavicular lymphadenopathy (< 1 cm in diameter). Digital tomography of the chest showed bilateral multiple cavities with areas of ill defined consolidation and air bronchograms (fig 2). Repeated cytological examination of sputum detected no malignant cells and no pathogenic organisms were isolated from cultures. Bronchoscopy showed diffuse redness of the bronchial mucosa but no endobronchial lesion. Transbronchial biopsy specimens from the anterior branch of the right upper lobe bronchus and the inferior branch of the lingular bronchus showed bronchiolar carcinoma histologically. Alveolar architecture was preserved but the alveolar spaces were lined with mildly pleomorphic cuboidal or columnar tumour cells.