Pulmonary metastases

Dr / Hytham Nafady

Typical pulmonary metastases

CXR:• Multiple nodules of variable size, with

basal & subpleural predominance.CT:• Nodules are sharply defined & of rounded

contour.• Feeding vessel sign: these nodules may

be seen in relation to small vascular branches.

Atypical pulmonary metastases

• Miliary metastases.• Canon ball metastases.• Calcified metastases.• Hemorrhagic metastases.• Cavitating metastases.• Embolic metastases.• Endobronchial metastases.• LN metastases.• Lymphangitis carcinomatosis.• Pleural metastases.• Chest wall metastases.• Metastasis + pneumothorax.

Miliary metastases

• Thyroid papillary CA (snow storm).

• Melanoma.

• Adenocarcinoma.

• Sarcoma.

Miliary metastases

Breast carcinoma.

Miliary metastases

Breast carcinoma.

Cannon ball metastases

• Renal cell carcinoma.

• Germ cell tumors.

• Colon carcinoma.

Cannon ball metastases

Calcified metastases

• Osteosarcoma.

• Chondrosarcoma.

• Mucinous adenocarcinoma of the colon.

Hemorrhagic metastases

• Angiosarcoma.

• Choriocarcinoma.

Hemorrhagic metastasisHalo sign

Cavitating metastases

• Squamous cell carcinoma.

• Transitional cell carcinoma.

• Adenocarcinoma of the colon.

• Some sarcomas.

• After chemotherapy.

Cavitating metastases

Cystic metastases

Embolic metastases

Hematogeneous spread with no proliferation of metastases in the extravascular tissue.

Tumors that invade systemic veins or right atrium.

• Hepatocellular carcinoma.

• Renal cell carcinoma.

• Right atrial myxoma.

• Vascular filling defects.

• Beaded pulmonary arteries.

• Pulmonary oligemia.

• Pulmonary infarction.

• Central pulmonary arteries dilatation due to pulmonary hypertension.

Endobronchial metastases

• Renal cell carcinoma (most common).

• Breast carcinoma.

• Colon carcinoma.

Endobronchial metastasis from RCC

LN metastases

• Head & neck tumors including thyroid carcinoma.

• Renal cell carcinoma.

• Testicular tumors.

• Breast carcinoma.

• Melanoma.

LN metastases

LN metastases

Melanoma

Lymphangitis carcinomatosis

• Bronchogenic carcinoma.

• Breast carcinoma.

• Stomach.

• Colon.

• Pancreas.

• Prostate.

Lymphangitis carcinomatosis

Lymphangitis carcinomatosis

Pleural metastases

RCC

Malignant pleural effusion

Malignant pleural effusion

Metastasis with pneumothorax

Chest wall metastases

Chest wall metastases