Jurnal Reading

Rachindi Qory Trysia (611 11 011)

Sari Rezeki (611 11 019)
Yuliazra (611 11 064)
Intan Delima Rizki (611 12 064)

Pembimbing :
dr. Dieby Adrisyel, Sp.Rad

KEPANITERAAN KLINIK ILMU RADIOLOGI

RUMAH SAKIT UMUM DAERAH EMBUNG FATIMAH KOTA BATAM
FAKULTAS KEDOKTERAN UNIVERSITAS BATAM
2017
 Typical and Atypical
Radiologic Presentation
of Pulmonary
Metastases
LEARNING OBJECTIVE
1. to describe the imaging features
of typical pulmonary metastases
2. to illustrate the spectrum of
radiologic findings seen in
atypical pulmonary metastases
3. to outline the spectrum of
diseases that may mimic
metastatic lung involvement in
oncology patients
Background
1. Tipical imaging findings of pulmonary
metastatic neoplasm :
. multiple round solid nodules
(hematogenous)
. Diffuse thickening of the
interstitium (lymphangitic
carcinomatosis)
2. Sometimes, however, metastatic
tumor presents with atypical
radiologic findings and may simulate
other conditions.
Typical and atypical radiologic features
of pulmonary metastases
1. Atypical nodules and
masses
Solitary Nodule
Cavitary Nodules
Calcified Nodules
Typical metastatic Nodules With CT- Halo
involment : Sign
Dilated Vessel Within A
Multiple nodules Mass
Lymphangitic
carcinomatosis 2. Pneumothoraks
3. Endobronchial
metastases

4. Air space pattern

5. Nonmalignant lesions
Sterilised metastases
Typical METASTATIC
1. MULTIPLE ROUND
NODULES
Most common radiologic finding of pulmonary
metastasis.
The nodules tent to be :
- Round or oval, or lobulated contours
- Smooth and sharply defines margins poorly
defined or irregular margins (if local invasion,
desmoplastic reaction or surrounding
hemorrhage)
- Size and number of nodules vary greatly from
miliary (1-4 mm) to cannon ball metastases
 Differential diagnosis :
1. Infection (TB, fungal, septic)
2. Non-infection inflammatory Disease
a. Sarcoidosis
b. Wegener Granulomatosis
c. Rheumoatoid Nodules
2. LYMPHANGITIC
CARCINOMATOSIS
Hematogenous or from direct lymphatic spread
and hilar lymph nodes
Characterized : smooth, nodular thickening of the
axial interstitium (peribronchovascular
interstitium), and peripheral interstitium
(interlobular septa and subpleural interstitium)
50% bilateral diffuse, 50% focal, unilateral or
asymmetric
Hilar lymphadenopathy and pleural effusion may
also be present
 Differential Diagnosis :
1.Nodular thickening of the
interstitium (sarcoidosis, silicosis,
coal workers pneumoconiosis)
2.Smooth thickening of the
interstitium (edema)
ATYPICAL METASTATIC
Atypical metastasic involvement
a) Solitary nodule
Occasionally, a metastatic tumor can present
as a solitary nodule biopsy

Differential diagnosis :
)Benign and malignant neoplasms carcinoid,
Hamartoma, Primary lung carcinoma,
lymphoma
)Infections - fungal infections, round
pneumonia, tuberculosis
)Noninfections inflammatory diseases
wegener granulomatosis, rheumatoid nodules
b.Cavitary nodules
Differential diganosis:
1. Infections septic emboli, lung
abscess, fungal infections,
tuberculosis and nontuberculosis
mycobacterial infections
2. Noninfectious inflammatory
diseases wegener granulomatosis,
rhematoid nodules
3. Primary lung carcinoma
4. Pulmonary infacrtion.
b.Calcified nodules
- Mechanisms responsible for calcifications
include
bone formation (osteosarcoma),
dystrophic calcification (treated metastasis),
and mucoid calcification (gastrointestinal tract
adenocarcinoma)

Differential diagnosis :
calcifications in granulomas and
hamartomas
d. Nodules with CT halo sign (a halo of ground-glass
opacity)
differential diagnosis :
- fungal infections
- noninfectious inflammatory diseases (eosinophilic
pneumonia)
- primary lung adenocarcinoma
- lymphoma
e. Dilated vessels within a mass
differrential diagnosis :
vascular lesions arteriovenous fistula,
pulmonary artery aneurysm
2. Pneumotharax
Pneumothorax seems to occur more often in patients
with metastases from sarcomas than in patients with
carcinoma.
Differential diagnosis:
- Iatrogenic, traumatic or spontaneous pneumothorax
associated to underlying lung diseases.
3. Endobronchial Metastasis
Endobronchial involvement occurs either by
direct deposition of tumor cells to the bronchial
wall, lymphatic spread, or hematogenous spread
or by local invasion of tumor from the adjacent
lymph nodes or lung parenchyma into to the
airway wall.
At imaging, a tapered narrowing of the airway lumen
("rat-tail" appearance), or sessile or polypoid
endobronchial mass may be observed.
Differential diagnosis
Primary neoplasms
Pneumothorax
Endobronchial metastasis
4. Air space pattern
Air-space pattern is characterized by the presence of
air-space nodules. parenchymal consolidation with air
bronchogram and/or angiogram sign, ground-glass
opacities, or nodules with a "CT halo" sign.

Differential diagnosis:
- Pneumonia
- Edema
- Hemorrhage
- Lymphoma
- Primary Lung Adenocarcinoma
air space pattern
Air space pattern (lymphoma)
5. NON-MALIGNANT
METASTASES
A.STERILIZED METASTASES
.Residual or mass with no viable
tumor cells that may persist at
imaging after chemotherapy in some
malignancies (choriocarcinoma and
testicular cancer)
.Surgical resection, these lesions are
discovered to be only necrotic
nodules with or without fibrosis .
.DD : residual viable tumor
Sterilized metastases
B. BENIGN METASTASIZING TUMORS
Rarely, benign tumors (leiomyoma of
the uterus, a hydatidiform mole of the
uterus, a giant cell tumor of the bone, a
chondroblastoma, a pleomorphic
adenoma of the salivary gland, or a
meningioma) may metastasize to the
lung.
DD : hematogenous metastases from a
malignant tumor
CONCLUSION
Pulmonary metastases have widely variable
presentation on imaging and may simulate primary
lung tumor or nonmalignant diseases.
Therefore, it is important for the radiologist to be
familiar with the full spectrum of findings to facilitate
correct diagnosis.
REFERENCES
1. Seo JB, Im JG, Goo JM, Chung MJ, Kim MY. Atypical pulmonary
metastases: spectrum of radiologic findings. Radiographics.
2001 Mar-A pr. 21(2):403-17.
2. Webb R. Metastatic Tumor. Thoracic Imaging. 2nd edition. 1-43.
3. Gill RR, Matsusoka S, Hatabu H. Cavities in the lung in oncology
patients: imaging overview and differential diagnoses. Applied
Radiology. 2010;39(6):10-21.
4. Gaeta M, Volta S, Scribano E, Loria G, Vallone A, Pandolfo I. Air-
space pattern in lung metastasis from adenocarcinoma of the GI
tract. J Comput Assist Tomogr 1996; 20:300-304.
5. Tateishi U, Hasegawa T, Kusumoto M, Yamazaki N, Iinuma G,
Muramatsu Y. Metastatic angiosarcoma of the lung: spectrum of
CT findings. AJR Am J Roentgenol. 2003 Jun. 180(6):1671-4.
TERIMA KASIH