We thank Johnson for reminding us that in some cases, pulmonary arterial and lymphatic carcinomatosis may be diagnosed prior to death using right heart catheterization and cytologic examination of withdrawn blood.1 The authors of the referenced study conclude, however, that malignant cells in blood obtained from the procedure constitute presumptive evidence of intravascular carcinomatosis and do not advocate the procedure as the diagnostic method of choice. Regardless, in the case we reported, such tests were not performed and autopsy was required to make the diagnosis, which was a major point of our case report.2 We would also like to point out that in the study Johnson cites, autopsy was used as part of the study protocol to validate the effectiveness of the right heart catheterization procedure for the purpose of detecting lymphangitic carcinomatosis, illustrating another useful aspect of the autopsy.
Hanzlick R, Pfeifer EA, Bjornsson J. Pulmonary Arterial Carcinomatosis vs Pulmonary Embolism. Arch Intern Med. 1998;158(11):1276. doi: