Bard's Syndrome: A Rare Case Presentation of Pulmonary Miliary Metastases of Gastric Carcinoma

Abstract

The Bard's syndrome is a rare desease related to miliary dissemination of gastric cancer to the lungs. The symptoms of primary neoplasm are subclinic despite the advanced proliferative process, and the metastatic lesions cause many respiratory symptoms suggesting primary pulmonary pathology, which explain the difficulties in diagnosis between numerous diseases. We report the case of a 39-year-old man presented for a chest pain, progressive worsening dyspnea appeared one month ago, dry cough, apyrexia, fatigue and weight loss. The chest CT scan showed a disseminated  micronodular lesions, a thickened interlobular septa and  mediastinal lymphadenopathy. Flexible bronchoscopy showed a diffuse inflammation on the entire bronchial tree. Staged bronchial biopsies revealed the presence of metastatic carcinoma, stomach in origin. The cytologic examination from bronchial aspirate reveal the presence of neoplasic cells. After re-interviewing the patient, he reported the history of intermittent epigastralgia, so we completed by an oesophageal-gastro-duodenal fibroscopy that confirmed the gastric adenocarcinoma and the diagnosis of bard’s syndrome was made with gastric adenocarcinoma with pulmonary lymphangitic carcinomatosis.