CXR Case 077

There are multiple small nodular lesions bilaterally, with a predominately basal distribution.
No pleural involvement.

This is leiomyomatosis.

The basal distribution and multiple different sizes of lesions suggests haematogenous spread of tumour, in this case uterine myomas.

Leiomyomatosis is results from haematogenous spread of ‘benign’ uterine fibroid.
There is commonly a venous tumour burden, masquerading as DVT / PE.
Treatment is with hysterectomy and anti oestrogen / gonadotrophin analogues as the cells are very hormone responsive.
There is a rare hereditary form of leiomyomatosis that also includes renal cell cancer and cutaneous lesions