Faces of Metastases Metastasis from Head and Neck Cancer Presenting as Lymphangitis Summary of the Events Over 3 MonthsImages a and b show the initial presentation of disease characterised by right upper lobe changes in a few secondary lobules characterised by thickening of the septa and prominence of the centrilobular nodules. 3 months later (c and d) the patient presented with a cough A large right upper lobe consolidative mass and progressive involvement of more secondary lobules with thickening of interlobular septa is noted. These findings likely reflect lymphangitis carcinomatosaAshley Davidoff MD TheCommonVein.net 013Lu 13606cL