Bilateral Pulmonary Hilar Lymphadenopathy

Abstract

Four patients with bilateral pulmonary hilar adenopathy secondary to lymphangitic spread from renal cell carcinoma were examined. Two additional cases had adenopathy secondary to nasopharyngeal carcinoma. Patients may initially present with bilateral pulmonary lymphadenopathy or as late as 3 1/2 yr after the discovery of the primary renal tumor. The mechanism of lymphangitic spread is probably related to reflux of tumor emboli from the thoracic duct into the bronchomediastinal trunks because of incompetent lymphatic valves. In 1 case Ga imaging demonstrated bilateral hilar isotopic uptake as well as periaortic uptake.