Endgames Spot Diagnosis

An unusual cause of chest pain

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3438 (Published 17 August 2017) Cite this as: BMJ 2017;358:j3438
  1. Kevin Conroy, respiratory medicine ST5,
  2. Abdul Aziz, consultant in respiratory medicine
  1. Queen Elizabeth Hospital, Gateshead, UK
  1. Correspondence to K Conroy kevin.conroy{at}nhs.net

A 65 year old man with a 40 pack year smoking history described a one month history of worsening breathlessness and chest discomfort on walking. He presented to hospital following a collapse after self-administering sublingual glyceryl trinitrate to relieve his symptoms. He reported no history of cough or coryza and had neither lost weight nor experienced any haemoptysis. A chest radiograph was taken (fig 1). What is the most likely diagnosis?

Fig 1 Chest radiograph on admission

Answer

Lymphangitis carcinomatosa and underlying malignancy would account for this radiograph appearance and history.

Discussion

Lymphangitis carcinomatosa describes …

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