“Chronic refractory cough with dyspnea” as presenting feature of metastatic renal cell carcinoma: “Beaded Interlobular Septum” on HRTC Thorax Needs Cautious Workup to Rule out Underlying Malignant Pathology

Abstract

Cough is the most common respiratory symptoms with infective and noninfective etiological factors involving upper and lower airways. Chronic refractory cough (CRC) has limited etiology and associated symptoms play a crucial role in differentiating it from underlying benign to malignant pathology. Computed tomography (CT) thorax has a vital role in evaluating “CRC with dyspnea” and findings like interlobular septal thickening with nodules will be good answer to etiology. “Beaded interlobular septum with nodules, and enhancing cannonball like nodule” clinching causative factor may be malignant process outside the thoracic cavity. In this case report, a 52-year male presented with CRC and documented lymphangitis with nodule on high-resolution computed tomography thorax and CT abdomen documented right renal mass, ultrasound-guided right renal biopsy documented renal papillary carcinoma. Renal metastasis which predominantly involves both lymphatic and hematogenous route, and propensity of these metastases are hyper-vascular type and presenting with lymphatic interlobular septal dissemination with lymphatic edema resulting in refractory chronic cough with dyspnea which is refractory to steroids and bronchodilators.