Thoracic Imaging 2003 - Society of Thoracic Radiology

Thoracic Metastates from Osteosarcoma
• Frequent
• Lungs are initially the sole site of metastasis in most patients
• Aggressive resection of pulmonary metastases
• Single or multiple nodules - calcification
- cavitation
• Spontaneous pneumothorax
Thoracic Metastases from CNS
• Rare
• Meningioma – usually prior surgery or shunting
Nodular Metastases
• Multiple, lower lung, variable size, peripheral
• May occur in relation to peripheral pulmonary arteries (CT)
but more commonly eccentric or peripheral in 2° lobule
• Rarely miliary
• Acinar nodules (stomach, pancreas)
• Lepidic grown similar to BAC
• CT (especially “cine” spinal CT on workstation) highly sensitive
• Specificity is lower – granulomas and nodes
• DDX sarcoidosis, silicosis, amyloidosis, granulomas
Nodular Metastases
• Halo of GGO – highly vascular or hemorrhagic tumours
(angiosarcoma, chorio)
Nodular Metastases
• Nodular or beaded thickening of the peripheral pulmonary aa
• Intravascular tumour emboil
Solitary Lung Metastases
Relatively uncommon (2-10% of SPN)
Colon (esp. rectosigmoid) 30-40%
Sarcomas (bone), kidney, breast, testis, melanoma
• Usually smooth and well-defined but may be irregular or
spiculated
• Squamous Ca elsewhere – new primary lung (us squamous)
• Adeno Ca elsewhere – equal chance of new 1 ° vs 2 °
• Soft tissue tumour, bone sarcoma, melanoma elsewhere -
metastatic
• 5 year survival postresection – 25-30%
Sterilized Metastases
• Testicular Ca
• Chorio Ca
Lymphangitic Carcinomatosis – Chest Radiology
Reticular/nodular infiltrate
Kerley B lines unilateral findings – lung
Pleural/subpleural edema – breast
Hilar/mediastinal adenopathy – (20-40%)
Pleural effusion (30-50%)
• ?specificity of findings - low
• sensitivity ~50%
Lymphangitic Carcinomatosis – HRCT
Irregular or nodular thickening of bronchovascular bundles
Polygonal lines; interlobular septal thickening
Increased number/thickness of interstitial lines
Nodules
Thickening/irregularity or nodularity of fissures
Adenopathy