Multiple Pulmonary Nodules in an Elderly Woman

Abstract

72-year-old woman presented to the outpatient department with a 2-month history of a nonproductive cough and a 5-lb weight loss. She was a lifelong nonsmoker. Her physical examination was unremarkable. Chest radiography revealed multiple bilateral ill-defined nodules with multifocal right lung alveolar infiltrates (Fig. 1). A chest computed tomography scan after the administration of intravenous contrast showed multiple noncalcified nodules of varying size throughout both lungs, as well as alveolar infiltrates scattered throughout the right lung (Fig. 2A–C). Bronchoscopic lung biopsy samples of the right lower and right upper lobes showed adenocarcinoma with bronchioloalveolar features. Bronchioloalveolar carcinoma (BAC) is a subset of pulmonary adenocarcinoma with several unique features. It accounts for 4% of all non-small cell lung cancer, although its incidence is rising. 1 In sharp contrast to other forms of non-small cell lung cancer, women make up slightly more than half of BAC cases 1 and lifelong nonsmokers represent as many as one third of patients. 2,3 Not uncommonly, asymptomatic patients are discovered on routine chest radiography. The radiographic presentation of BAC fits one of three patterns: consolidation of one or more segments or lobes (37%–55% of the time); a solitary pulmonary nodule or mass (38% of the time), or multiple pulmonary nodules (7%–25% of the time). 2,4 Our patient’s radiographic evaluation demon