Pulmonary Metastasis


Multiple Lesions

Cannon Balls:

Miliary Pattern: This presentation is seen in patients with the following:

Cavitating Lesions:


Solitary Pulmonary Nodule

Diagnostic Strategy:


Endobronchial Lesion

Tracheal Metastasis

When the lesion is located in the trachea, patients will present with severe wheezing and have normal chest x-ray findings.


Pleural Effusion

Pleural Masses
  • Spontaneous pneumothorax
  • Pneumothorax occurring secondary to pulmonary metastasis is rare. 
  • This mode of presentation occurs secondary to necrosis of subpleurally located metastases with the resultant bronchopleural fistula. 
  • Cavitating sarcoma is reported to present in this manner.
  •  In some instances, the subpleural metastases are not sufficiently large enough to be recognized in x-rays and pneumothorax is the presenting manifestation.

Chest Wall Lesion

Alveolar Pattern

Interstitial Pattern

Subacute Cor Pulmonale
  • This form of presentation occurs when small subliminal tumor deposits obstruct a sufficient cross section of the pulmonary vascular bed. 
  • The spectrum of pulmonary symptoms is identically to thromboembolism.
  •  Patients are in prolonged respiratory distress with normal chest x-ray, and with or without signs of pulmonary hypertension. 
  • Choriocarcinoma, hepatoma, breast and stomach tumors account for most of the primaries with such presentation. 
  • This entity should be considered in a female with severe respiratory distress with a history of recent abortion or delivery chorionic gonadotropin levels are high. 
  • When recognized, chemotherapy offers a favorable prognosis in patients with choriocarcinoma. 
  • Prognosis is poor with other primary malignancies.