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In the January 12, 1998, issue of the ARCHIVES, "Autopsy and Medicine" Case of the Month series¹ and the subsequent letter "Pulmonary Arterial Carcinomatosis vs Pulmonary Embolism" by Dr Johnson,² the discussion appears incomplete to me. The well-known disease entity formerly known as lymphangitic pulmonary metastases (LPM) (which seems to have disappeared from most text books) was and continues to be characterized clinically by severe respiratory insufficiency with hypoxemia, pathologically by widespread lymphatic metastases, and radiologically by bilateral reticular infiltrates. In 1971, Janower and Blennerhassett³ showed that patients with LPM had tumor emboli in the pulmonary arterial vasculature, which was probably responsible for the severe physiological abnormalities present in this condition. They suggested the LPM—commonly associated with reticular infiltrates on chest films—occurs secondary to tumor embolization. Pulmonary arterial carcinomatosis microemboli (PACME) leads sequentially to LPM. Chest x-ray films may not show abnormalities in the former and abnormalities in the latter. . . . [Full Text of this Article]