2. Dr. Manmohan Bir Shrestha
MD Resident, Phase-A
Department of Radiology & Imaging
3. Metastasis
Metastasis are the tumor implants discontinuous with
primary tumor.
It is the hallmark of malignancy.
All cancers can metastasize with few exceptions. The
major exceptions are gliomas and basal cell carcinoma.
4. Pulmonary Metastases
In about 75 % cases, presents as multiple pulmonary
nodules.
Also present as solitary pulmonary nodule/ cavitation/
calcification.
Approximately 3 % of asymptomatic pulmonary
nodules are metastases.
5. Site
Usually bilateral, affecting both lungs equally with a
basal predominance.
They are often peripheral and may be subpleural.
6. Route of spread
Most commonly - haematogenous.
Lymphatic spread - less common.
Endobronchial spread - rare
7. Lungs – Filter like Organ
Supplied by pulmonary artery containing
deoxygenated blood from right ventricle.
This blood contains lymphatic fluid from the body
tissues which flows into the lungs.
8. Primary site
May originate at any site.
Approximately 80 % of pulmonary metastases
arise from primary tumours of-
• Breast
• Skeleton
• Urogenital system.
9. Clinical features
Cough
Dyspnea or shortness of breath
Chest pain
Haemoptysis
Hoarseness of voice
Features of secondary pulmonary infection.
10. Radiological findings
Common Other patterns
Nodules. Cavitation
Calcification
Pneumonia-like consolidation
A halo of ground glass opacity.
Endobronchial
Cannon-ball metastases
Miliary metastases
Lymphangitis carcinomatosa.
11. Nodules
May be solitary or multiple.
Rounded nodules of variable sizes ranging from few
millimeters to few centimeters with well-defined margin.
75 % - multiple pulmonary nodules.
Commonest tumours producing solitary pulm. nodules are
carcinomas of –
• Colon
• Kidney
• Breast
• Testicular tumours
• Bone sarcomas
• Malignant melanoma.
12.
13.
14.
15. Cavitation
May occur from any site.
More common from-
• Squamous carcinomas from head & neck
• Sarcomas.
May be seen after chemotherapy
Subpleural cavitation is a recognized cause of spontaneous
pneumothorax.
Absent fluid levels.
16.
17.
18. Calcification
Is seen in some cases.
Most often in
• Osteogenic sarcoma
• Chondrosarcoma
• Mucinous adenocarcinoma.
20. A halo of ground-glass opacity
Ground-glass opacity
surrounding a mass or a
nodule which
represents
haemorrhage.
Seen in
choriocarcinoma &
angiosarcoma.
21. Endobronchial metastases
Rare
They may occlude the airway and cause segmental or
lobar collapse.
Primary sites being
• Kidney
• Breast
• Large bowel.
25. Lymphangitis Carcinomatosa
Results from haematogenous metastases invading and
occluding peripheral pulmonary lymphatics.
Commonest primary sites are
Lung
Breast
Stomach
Pancreas
Cervix
prostate
26. Cont…
Usually bilateral, but lung and breast cancer may
cause unilateral lymphangitis.
Chest X-ray
Coarse, linear, reticular and nodular basal shadowing
often with pleural effusions and hilar
lymphadenopathy.
27.
28. Cont…
HRCT
Nodular thickening of the interlobular septa and
thickening of the centrilobular bronchovascular
bundles.