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Segmental contour mapping pattern in a patient with breast carcinoma.

A 56-year-old woman status post bilateral mastectomies, chemotherapy, and radiation treatment of breast cancer presented with dyspnea and associated pleuritic chest pain, fatigue, and chest heaviness. Imaging studies including a chest radiograph, lower extremity color Doppler ultrasound, computed tomography pulmonary angiogram, and high-resolution chest CT (HRCT) were all negative. Lung scan revealed contour mapping of the bronchopulmonary segments, a pattern which can be seen in patients with tumor emboli syndrome or lymphangitic carcinomatosis. A pulmonary angiogram with microvascular cytologic sampling revealed no pulmonary embolus but confirmed the presence of malignant cells identical to the patient's breast cancer.