Case 54. (9 Nov. 1998)

Diagnosis: Adenocarcinoma with cystic lung to lung metastasis

Findings
    Chest CT scans show a spiculated mass in the apex of the left lung with multiple small nodular lesions in both lungs. Some of the nodules appear as cavitary or ring-like lesions.

Discussion
    Cavitation of metastatic nodules is not as common as with primary lung carcinoma. The frequency of it is 4%, in contrast to 9% of primary lung carcinomas. Among metastatic nodules associated with cavitation, 70% are metastatic squamous cell carcinoma. The head and neck in males and the genitalia in females are the most common primary organ sites. Cavitation is observed rarely in metastatic adenocarcinoma, particularly that from colon cancer. Metastatic sarcoma can also be accompanied by cavitation, and pneumothorax is a relatively frequent complication. Chemotherapy is known to induce cavitation in metastatic pulmonary nodules.

Reference
1. Dodd GD, Boyle JJ. Excavating pulmonary metastasis. AJR 1961;85:277-293
2. Chaudhuri MR. Cavitatory pulmonary metastasis. Thorax 1970;25:375-381
3. Libshitz HI, North LB. Pulmonary metastasis. Radiol Clin North Am 1982;20:437-451

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