Lucencies and Cavitation in Bronchioloalveolar Carcinoma

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The chest radiograph shows an ill-defined focal opacity in the left lower lung zone.

Coronal-reformatted CT image done a few days after the chest radiograph reveals an irregular-shaped mass with internal lucencies that represent air bronchiologram and cavity. Desmoplastic reaction is also visualized.

Facts: BAC

• Well-differentiated adenocarcinoma of the lung
• Polymorphism
• Lepidic growth meaning spread of neoplastic cells in peripheral air space without destroying lung architecture
• On CT, it can be a nodule, mass, consolidation (segmental or lobar), multi centric or diffuse disease

Facts: Radiolucencies in BAC

• Important CT feature is internal radiolucencies but this is overlapping with other diseases
• Lucencies can represent air bronchiologram, bubbles of pseudocavitation, cavitation, serpentine, alveologram or thin-walled cystic lesions
• Bubbly lucencies or pseudocavitation is believed to be non-involved lobules, paracicatricial emphysema and fibrosis with honeycombing and localized bronchiectasis.

Our case: BAC with air bronchiologram and cavity.

Reference:

Gaeta M, et al. Radiolucencies and cavitation in bronchioloalveolar carcinoma: CT-pathologic correlation. Eur Radiol 1999;9:55-59.