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Pulmonary metastases

Changed by Mohammad Taghi Niknejad, 24 Oct 2022
Back to revision history
Disclosures - updated 16 Jul 2022: Nothing to disclose

Updates to Article Attributes

Body was changed:

Pulmonary metastases refer to distant tumour spread from a variety of primary tumours to the lungs via the blood or lymphatics.

This article primarily describes haematogenous pulmonary metastases while lymphangitic carcinomatosis is discussed separately.

Epidemiology

Lung metastases are common. The incidence of synchronous lung metastasis at initial cancer presentation is about 18 per 100,000, noting this figure does not include metachronous metastases (occurring after initial cancer staging) 8. The incidence is slightly higher in males (20 in 100,000) than females (16 in 100,000) 8. The specific epidemiology reflects that of the underlying malignancies (see below).

As malignancies increase in incidence with increasing age, so does the incidence of synchronous pulmonary metastases. Below age 40, the incidence is about 1 in 100,000, while above age 40, the incidence is about 40 in 100,000 8. The peak incidence reaches 116 per 100,000 in patients age 80-84 8.

Clinical presentation

Pulmonary metastases are usually asymptomatic, with constitutional symptoms relating to disseminated metastatic disease and those attributable to the primary tumour dominating 5. Haemoptysis, dyspnoea, and pneumothorax are sometimes the presenting symptoms.

Pathology

Tumour cells reach the lungs via the pulmonary circulation, where they lodge in small distal vessels.

Aetiology

The most common malignancies to present with pulmonary metastases are the following that predominate in middle age to older adults, each occurring with an incidence of greater than 1 in 100,000 8:

In young men aged 15 to 40, testicular cancer is the most common cause of synchronous lung metastasis 8.

In adolescents aged 10 to 20, bone and soft tissue sarcomas are the major sources in both sexes 8. Under age 10, kidney and soft tissue tumours dominate 8. The most common primaries for paediatric pulmonary metastases are the following histologies:

Alternatively, primaries that most frequently metastasise to lungs (although are much less common) include 1,3:

Primaries that metastasise as endobronchial deposits can include:

Radiographic features

Pulmonary metastases typically appear as multiple, peripheral, rounded nodules scattered throughout both lungs 1. Larger nodules and masses may be termed cannonball metastases. Atypical features include consolidation, cavitation, cystic change, calcification, ossification, haemorrhage, and secondary pneumothorax.

Plain radiograph

Plain films are insensitive, although frequently able to make the diagnosis, as often pulmonary metastases are large and numerous.

CT

CT is excellent at visualising pulmonary nodules. Typically, metastases appear of soft tissue attenuation, well circumscribed, rounded lesions, more often in the periphery of the lung. They are usually of variable size, a feature which is of some use in distinguishing them from a granuloma 3.

A prominent pulmonary vessel has frequently been noted heading into a metastasis. This has been termed the feeding vessel sign 4. It is unclear whether this is a true finding or the result of older scanners with thicker slices resulting in volume averaging 4. However, a number of atypical features are commonly encountered.

Some tumours have a predilection for innumerable small metastases (miliary pattern):

Conversely, a pulmonary metastasis may be single. This is most frequently seen in colorectal carcinoma but can be seen with other primary tumours 3:

Adenocarcinoma metastases, rather than displace or destroy adjacent lung parenchyma, may grow in a lepidic fashion (spread along alveolar walls) resulting in pneumonia-like consolidation. Air bronchograms may also be visible 1.

Cavitation is present in ~4% of cases 1. The most common primary is squamous cell carcinoma, most often from the head and neck or from the lung. Other primaries include adenocarcinomas, and sarcomas 1,3.

Calcification, although uncommon and more frequently a feature of benign aetiology (e.g. granuloma or hamartoma) is also seen with metastases, particularly those from papillary thyroid carcinoma and adenocarcinomas. Treated metastases, osteosarcomas and chondrosarcomas may also contain calcified densities 1.

A halo of ground-glass opacity representing haemorrhage can be seen, particularly surrounding haemorrhagic pulmonary metastases, such as choriocarcinoma and angiosarcoma 1.

MRI

Although not used routinely, MRI may be as sensitive in the detection of pulmonary metastases as CT 2,4.

Treatment and prognosis

In general, pulmonary metastases are an ominous finding, indicating poor prognosis. The specific prognosis will, however, depend on the primary tumour.

Complications

Tumours with prominent necrosis located near a pleural surface may result in a pneumothorax. Osteosarcoma is classically described as the pulmonary metastasis that results in pneumothorax. Another cause of pneumothoraces includes cystic or cavitary pulmonary metastases.

Differential diagnosis

The differential depends on the number of nodules/masses and their imaging characteristics.

See also

  • -<p><strong>Pulmonary metastases</strong> refer to distant tumour spread from a variety of primary tumours to the <a href="/articles/lung">lungs</a> via the blood or lymphatics.</p><p>This article primarily describes haematogenous pulmonary metastases while <a href="/articles/lymphangitic-carcinomatosis">lymphangitic carcinomatosis</a> is discussed separately.</p><h4>Epidemiology</h4><p>Lung metastases are common. The incidence of synchronous lung metastasis at initial cancer presentation is about 18 per 100,000, noting this figure does not include metachronous metastases (occurring after initial cancer staging) <sup>8</sup>. The incidence is slightly higher in males (20 in 100,000) than females (16 in 100,000) <sup>8</sup>. The specific epidemiology reflects that of the underlying malignancies (see below).</p><p>As malignancies increase in incidence with increasing age, so does the incidence of synchronous pulmonary metastases. Below age 40, the incidence is about 1 in 100,000, while above age 40, the incidence is about 40 in 100,000 <sup>8</sup>. The peak incidence reaches 116 per 100,000 in patients age 80-84 <sup>8</sup>.</p><h4>Clinical presentation</h4><p>Pulmonary metastases are usually asymptomatic, with constitutional symptoms relating to disseminated metastatic disease and those attributable to the primary tumour dominating <sup>5</sup>. <a href="/articles/haemoptysis-1">Haemoptysis</a>, dyspnoea, and <a href="/articles/pneumothorax">pneumothorax</a> are sometimes the presenting symptoms.</p><h4>Pathology</h4><p>Tumour cells reach the lungs via the pulmonary circulation, where they lodge in small distal vessels.</p><h5>Aetiology</h5><p>The most common malignancies to present with pulmonary metastases are the following that predominate in middle age to older adults, each occurring with an incidence of greater than 1 in 100,000 <sup>8</sup>:</p><ul>
  • -<li>
  • -<a href="/articles/lung-cancer-3">lung cancer</a> (most common primary site)</li>
  • -<li><a href="/articles/colorectal-cancer-1">colorectal cancer</a></li>
  • -<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></li>
  • -<li><a href="/articles/pancreatic-neoplasms">pancreatic cancer</a></li>
  • -<li><a href="/articles/breast-carcinoma">breast cancer</a></li>
  • -</ul><p>In young men aged 15 to 40, <a href="/articles/testicular-cancer">testicular cancer</a> is the most common cause of synchronous lung metastasis <sup>8</sup>.</p><p>In adolescents aged 10 to 20, <a href="/articles/who-classification-of-tumors-of-bone">bone</a> and <a href="/articles/who-classification-of-tumors-of-soft-tissue">soft tissue</a> sarcomas are the major sources in both sexes <sup>8</sup>. Under age 10, <a href="/articles/who-classification-of-tumours-of-the-kidney">kidney</a> and soft tissue tumours dominate <sup>8</sup>. The most common primaries for paediatric pulmonary metastases are the following histologies:</p><ul>
  • -<li><a href="/articles/rhabdomyosarcoma">rhabdomyosarcoma</a></li>
  • -<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
  • -<li><a href="/articles/wilms-tumour">Wilms tumour</a></li>
  • -<li><a href="/articles/ewing-sarcoma">Ewing sarcoma</a></li>
  • -<li>
  • -<a href="/articles/neuroblastoma">neuroblastoma</a><sup> 7</sup>
  • -</li>
  • -</ul><p>Alternatively, primaries that most frequently metastasise to lungs (although are much less common) include <sup>1,3</sup>:</p><ul>
  • -<li><a href="/articles/choriocarcinoma">choriocarcinoma</a></li>
  • -<li><a href="/articles/ewing-sarcoma">Ewing sarcoma</a></li>
  • -<li><a href="/articles/malignant-melanoma">malignant melanoma</a></li>
  • -<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
  • -<li><a href="/articles/testicular-cancer">testicular tumours</a></li>
  • -<li><a href="/articles/thyroid-malignancies">thyroid carcinoma</a></li>
  • -<li>
  • -<a href="/articles/pancreatic-neoplasms">pancreatic cancer</a> <sup>6</sup>
  • -</li>
  • -</ul><p>Primaries that metastasise as endobronchial deposits can include:</p><ul>
  • -<li><a href="/articles/colorectal-cancer-1">colorectal carcinoma</a></li>
  • -<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></li>
  • -<li><a href="/articles/lung-cancer-3">lung cancer</a></li>
  • -<li><a href="/articles/lymphoma">lymphoma</a></li>
  • -</ul><h4>Radiographic features</h4><p>Pulmonary metastases typically appear as multiple, peripheral, rounded nodules scattered throughout both lungs <sup>1</sup>. Larger nodules and masses may be termed <a href="/articles/cannonball-metastases-lungs">cannonball metastases</a>. Atypical features include <a href="/articles/air-space-opacification-1">consolidation</a>, <a href="/articles/cavitating-pulmonary-metastases">cavitation</a>, <a href="/articles/cystic-pulmonary-metastases">cystic change</a>, <a href="/articles/calcifying-pulmonary-metastases">calcification</a>, <a href="/articles/ossifying-pulmonary-metastases">ossification</a>, <a href="/articles/haemorrhagic-pulmonary-metastases">haemorrhage</a>, and secondary <a href="/articles/pneumothorax">pneumothorax</a>.</p><h5>Plain radiograph</h5><p>Plain films are insensitive, although frequently able to make the diagnosis, as often pulmonary metastases are large and numerous.</p><h5>CT</h5><p>CT is excellent at visualising pulmonary nodules. Typically, metastases appear of soft tissue attenuation, well circumscribed, rounded lesions, more often in the periphery of the lung. They are usually of variable size, a feature which is of some use in distinguishing them from a granuloma <sup>3</sup>.</p><p>A prominent pulmonary vessel has frequently been noted heading into a metastasis. This has been termed the <a href="/articles/feeding-vessel-sign">feeding vessel sign</a> <sup>4</sup>. It is unclear whether this is a true finding or the result of older scanners with thicker slices resulting in volume averaging <sup>4</sup>. However, a number of atypical features are commonly encountered.</p><p>Some tumours have a predilection for innumerable small metastases (<a href="/articles/miliary-opacities-lungs">miliary pattern</a>):</p><ul>
  • -<li><a href="/articles/malignant-melanoma">malignant melanoma</a></li>
  • -<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
  • -<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></li>
  • -<li><a href="/articles/assessment-of-thyroid-lesions-general">thyroid carcinoma</a></li>
  • -<li>
  • -<a href="/articles/gestational-trophoblastic-disease">trophoblastic disease</a> <sup>3</sup>
  • -</li>
  • -</ul><p>Conversely, a pulmonary metastasis may be single. This is most frequently seen in colorectal carcinoma but can be seen with other primary tumours <sup>3</sup>:</p><ul>
  • -<li><a href="/articles/malignant-melanoma">malignant melanoma</a></li>
  • -<li>skeletal sarcoma</li>
  • -<li>testicular carcinoma</li>
  • -<li>adenocarcinomas in general</li>
  • -</ul><p>Adenocarcinoma metastases, rather than displace or destroy adjacent lung parenchyma, may grow in a <a href="/articles/lepidic-growth">lepidic</a> fashion (spread along alveolar walls) resulting in pneumonia-like consolidation. <a href="/articles/air-bronchogram">Air bronchograms</a> may also be visible <sup>1</sup>.</p><p>Cavitation is present in ~4% of cases <sup>1</sup>. The most common primary is squamous cell carcinoma, most often from the head and neck or from the lung. Other primaries include adenocarcinomas, and sarcomas <sup>1,3</sup>.</p><p>Calcification, although uncommon and more frequently a feature of benign aetiology (e.g. granuloma or hamartoma) is also seen with metastases, particularly those from <a href="/articles/papillary-thyroid-cancer">papillary thyroid carcinoma</a> and adenocarcinomas. Treated metastases, <a href="/articles/osteosarcoma">osteosarcomas</a> and <a href="/articles/chondrosarcoma">chondrosarcomas</a> may also contain calcified densities <sup>1</sup>.</p><p>A <a href="/articles/halo-sign-chest-3">halo</a> of <a href="/articles/ground-glass-opacification-3">ground-glass opacity</a> representing haemorrhage can be seen, particularly surrounding <a href="/articles/haemorrhagic-pulmonary-metastases">haemorrhagic pulmonary metastases</a>, such as <a href="/articles/choriocarcinoma">choriocarcinoma</a> and <a href="/articles/angiosarcoma">angiosarcoma</a><sup> 1</sup>.</p><h5>MRI</h5><p>Although not used routinely, MRI may be as sensitive in the detection of pulmonary metastases as CT<sup> 2,4</sup>.</p><h4>Treatment and prognosis</h4><p>In general, pulmonary metastases are an ominous finding, indicating poor prognosis. The specific prognosis will, however, depend on the primary tumour.</p><h5>Complications</h5><p>Tumours with prominent necrosis located near a pleural surface may result in a <a href="/articles/pneumothorax">pneumothorax</a>. <a href="/articles/osteosarcoma">Osteosarcoma</a> is classically described as the pulmonary metastasis that results in pneumothorax. Another cause of pneumothoraces includes cystic or cavitary pulmonary metastases.</p><h4>Differential diagnosis</h4><p>The differential depends on the number of nodules/masses and their imaging characteristics.</p><ul>
  • -<li><a href="/articles/diffuse-pulmonary-nodules-differential-diagnosis">differential of multiple pulmonary nodules</a></li>
  • -<li><a href="/articles/differential-of-a-single-pulmonary-nodule">differential of a single pulmonary nodule</a></li>
  • -<li><a href="/articles/miliary-opacities-lungs">differential of miliary pulmonary nodules</a></li>
  • -<li><a href="/articles/pulmonary-cavities-1">differential of a cavitating lung mass</a></li>
  • -<li><a href="/articles/hyperattenuating-pulmonary-mass-lesion">differential of a pulmonary mass with calcification</a></li>
  • -<li><a href="/articles/differential-of-a-pulmonary-mass-with-surrounding-ground-glass-halo">differential of a pulmonary mass with surrounding ground-glass halo</a></li>
  • -</ul><h4>See also</h4><ul>
  • -<li><a href="/articles/calcifying-pulmonary-metastases">calcifying pulmonary metastases</a></li>
  • -<li><a href="/articles/cannonball-metastases-lungs">cannonball pulmonary metastases</a></li>
  • -<li><a href="/articles/cavitating-pulmonary-metastases">cavitating pulmonary metastases</a></li>
  • -<li><a href="/articles/cystic-pulmonary-metastases">cystic pulmonary metastases</a></li>
  • -<li><a href="/articles/haemorrhagic-pulmonary-metastases">haemorrhagic pulmonary metastases</a></li>
  • -<li><a href="/articles/ossifying-pulmonary-metastases">ossifying pulmonary metastases</a></li>
  • +<p><strong>Pulmonary metastases</strong> refer to distant tumour spread from a variety of primary tumours to the <a href="/articles/lung">lungs</a> via the blood or lymphatics.</p><p>This article primarily describes haematogenous pulmonary metastases while <a href="/articles/lymphangitic-carcinomatosis">lymphangitic carcinomatosis</a> is discussed separately.</p><h4>Epidemiology</h4><p>Lung metastases are common. The incidence of synchronous lung metastasis at initial cancer presentation is about 18 per 100,000, noting this figure does not include metachronous metastases (occurring after initial cancer staging) <sup>8</sup>. The incidence is slightly higher in males (20 in 100,000) than females (16 in 100,000) <sup>8</sup>. The specific epidemiology reflects that of the underlying malignancies (see below).</p><p>As malignancies increase in incidence with increasing age, so does the incidence of synchronous pulmonary metastases. Below age 40, the incidence is about 1 in 100,000, while above age 40, the incidence is about 40 in 100,000 <sup>8</sup>. The peak incidence reaches 116 per 100,000 in patients age 80-84 <sup>8</sup>.</p><h4>Clinical presentation</h4><p>Pulmonary metastases are usually asymptomatic, with constitutional symptoms relating to disseminated metastatic disease and those attributable to the primary tumour dominating <sup>5</sup>. <a href="/articles/haemoptysis-1">Haemoptysis</a>, dyspnoea, and <a href="/articles/pneumothorax">pneumothorax</a> are sometimes the presenting symptoms.</p><h4>Pathology</h4><p>Tumour cells reach the lungs via the pulmonary circulation, where they lodge in small distal vessels.</p><h5>Aetiology</h5><p>The most common malignancies to present with pulmonary metastases are the following that predominate in middle age to older adults, each occurring with an incidence of greater than 1 in 100,000 <sup>8</sup>:</p><ul>
  • +<li>
  • +<a href="/articles/lung-cancer-3">lung cancer</a> (most common primary site)</li>
  • +<li><a href="/articles/colorectal-cancer-1">colorectal cancer</a></li>
  • +<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></li>
  • +<li><a href="/articles/pancreatic-neoplasms">pancreatic cancer</a></li>
  • +<li><a href="/articles/breast-carcinoma">breast cancer</a></li>
  • +</ul><p>In young men aged 15 to 40, <a href="/articles/testicular-cancer">testicular cancer</a> is the most common cause of synchronous lung metastasis <sup>8</sup>.</p><p>In adolescents aged 10 to 20, <a href="/articles/who-classification-of-tumors-of-bone">bone</a> and <a href="/articles/who-classification-of-tumors-of-soft-tissue">soft tissue</a> sarcomas are the major sources in both sexes <sup>8</sup>. Under age 10, <a href="/articles/who-classification-of-tumours-of-the-kidney">kidney</a> and soft tissue tumours dominate <sup>8</sup>. The most common primaries for paediatric pulmonary metastases are the following histologies:</p><ul>
  • +<li><a href="/articles/rhabdomyosarcoma">rhabdomyosarcoma</a></li>
  • +<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
  • +<li><a href="/articles/wilms-tumour">Wilms tumour</a></li>
  • +<li><a href="/articles/ewing-sarcoma">Ewing sarcoma</a></li>
  • +<li>
  • +<a href="/articles/neuroblastoma">neuroblastoma</a><sup> 7</sup>
  • +</li>
  • +</ul><p>Alternatively, primaries that most frequently metastasise to lungs (although are much less common) include <sup>1,3</sup>:</p><ul>
  • +<li><a href="/articles/choriocarcinoma">choriocarcinoma</a></li>
  • +<li><a href="/articles/ewing-sarcoma">Ewing sarcoma</a></li>
  • +<li><a href="/articles/malignant-melanoma">malignant melanoma</a></li>
  • +<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
  • +<li><a href="/articles/testicular-cancer">testicular tumours</a></li>
  • +<li><a href="/articles/thyroid-malignancies">thyroid carcinoma</a></li>
  • +<li>
  • +<a href="/articles/pancreatic-neoplasms">pancreatic cancer</a> <sup>6</sup>
  • +</li>
  • +</ul><p>Primaries that metastasise as endobronchial deposits can include:</p><ul>
  • +<li><a href="/articles/colorectal-cancer-1">colorectal carcinoma</a></li>
  • +<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></li>
  • +<li><a href="/articles/lung-cancer-3">lung cancer</a></li>
  • +<li><a href="/articles/lymphoma">lymphoma</a></li>
  • +</ul><h4>Radiographic features</h4><p>Pulmonary metastases typically appear as multiple, peripheral, rounded nodules scattered throughout both lungs <sup>1</sup>. Larger nodules and masses may be termed <a href="/articles/cannonball-metastases-lungs">cannonball metastases</a>. Atypical features include <a href="/articles/air-space-opacification-1">consolidation</a>, <a href="/articles/cavitating-pulmonary-metastases">cavitation</a>, <a href="/articles/cystic-pulmonary-metastases">cystic change</a>, <a href="/articles/calcifying-pulmonary-metastases">calcification</a>, <a href="/articles/ossifying-pulmonary-metastases">ossification</a>, <a href="/articles/haemorrhagic-pulmonary-metastases">haemorrhage</a>, and secondary <a href="/articles/pneumothorax">pneumothorax</a>.</p><h5>Plain radiograph</h5><p>Plain films are insensitive, although frequently able to make the diagnosis, as often pulmonary metastases are large and numerous.</p><h5>CT</h5><p>CT is excellent at visualising pulmonary nodules. Typically, metastases appear of soft tissue attenuation, well circumscribed, rounded lesions, more often in the periphery of the lung. They are usually of variable size, a feature which is of some use in distinguishing them from a granuloma <sup>3</sup>.</p><p>A prominent pulmonary vessel has frequently been noted heading into a metastasis. This has been termed the <a href="/articles/feeding-vessel-sign">feeding vessel sign</a> <sup>4</sup>. It is unclear whether this is a true finding or the result of older scanners with thicker slices resulting in volume averaging <sup>4</sup>. However, a number of atypical features are commonly encountered.</p><p>Some tumours have a predilection for innumerable small metastases (<a href="/articles/miliary-opacities-lungs">miliary pattern</a>):</p><ul>
  • +<li><a href="/articles/malignant-melanoma">malignant melanoma</a></li>
  • +<li><a href="/articles/osteosarcoma">osteosarcoma</a></li>
  • +<li><a href="/articles/renal-cell-carcinoma-1">renal cell carcinoma</a></li>
  • +<li><a href="/articles/assessment-of-thyroid-lesions-general">thyroid carcinoma</a></li>
  • +<li>
  • +<a href="/articles/gestational-trophoblastic-disease">trophoblastic disease</a> <sup>3</sup>
  • +</li>
  • +</ul><p>Conversely, a pulmonary metastasis may be single. This is most frequently seen in colorectal carcinoma but can be seen with other primary tumours <sup>3</sup>:</p><ul>
  • +<li><a href="/articles/malignant-melanoma">malignant melanoma</a></li>
  • +<li>skeletal sarcoma</li>
  • +<li>testicular carcinoma</li>
  • +<li>adenocarcinomas in general</li>
  • +</ul><p>Adenocarcinoma metastases, rather than displace or destroy adjacent lung parenchyma, may grow in a <a href="/articles/lepidic-growth">lepidic</a> fashion (spread along alveolar walls) resulting in pneumonia-like consolidation. <a href="/articles/air-bronchogram">Air bronchograms</a> may also be visible <sup>1</sup>.</p><p>Cavitation is present in ~4% of cases <sup>1</sup>. The most common primary is squamous cell carcinoma, most often from the head and neck or from the lung. Other primaries include adenocarcinomas, and sarcomas <sup>1,3</sup>.</p><p>Calcification, although uncommon and more frequently a feature of benign aetiology (e.g. granuloma or hamartoma) is also seen with metastases, particularly those from <a href="/articles/papillary-thyroid-cancer">papillary thyroid carcinoma</a> and adenocarcinomas. Treated metastases, <a href="/articles/osteosarcoma">osteosarcomas</a> and <a href="/articles/chondrosarcoma">chondrosarcomas</a> may also contain calcified densities <sup>1</sup>.</p><p>A <a href="/articles/halo-sign-chest-3">halo</a> of <a href="/articles/ground-glass-opacification-3">ground-glass opacity</a> representing haemorrhage can be seen, particularly surrounding <a href="/articles/haemorrhagic-pulmonary-metastases">haemorrhagic pulmonary metastases</a>, such as <a href="/articles/choriocarcinoma">choriocarcinoma</a> and <a href="/articles/angiosarcoma">angiosarcoma</a><sup> 1</sup>.</p><h5>MRI</h5><p>Although not used routinely, MRI may be as sensitive in the detection of pulmonary metastases as CT<sup> 2,4</sup>.</p><h4>Treatment and prognosis</h4><p>In general, pulmonary metastases are an ominous finding, indicating poor prognosis. The specific prognosis will, however, depend on the primary tumour.</p><h5>Complications</h5><p>Tumours with prominent necrosis located near a pleural surface may result in a <a href="/articles/pneumothorax">pneumothorax</a>. <a href="/articles/osteosarcoma">Osteosarcoma</a> is classically described as the pulmonary metastasis that results in pneumothorax. Another cause of pneumothoraces includes cystic or cavitary pulmonary metastases.</p><h4>Differential diagnosis</h4><p>The differential depends on the number of nodules/masses and their imaging characteristics.</p><ul>
  • +<li><a href="/articles/diffuse-pulmonary-nodules-differential-diagnosis">differential of multiple pulmonary nodules</a></li>
  • +<li><a href="/articles/differential-of-a-single-pulmonary-nodule">differential of a single pulmonary nodule</a></li>
  • +<li><a href="/articles/miliary-opacities-lungs">differential of miliary pulmonary nodules</a></li>
  • +<li><a href="/articles/pulmonary-cavities-1">differential of a cavitating lung mass</a></li>
  • +<li><a href="/articles/hyperattenuating-pulmonary-mass-lesion">differential of a pulmonary mass with calcification</a></li>
  • +<li><a href="/articles/differential-of-a-pulmonary-mass-with-surrounding-ground-glass-halo">differential of a pulmonary mass with surrounding ground-glass halo</a></li>
  • +</ul><h4>See also</h4><ul>
  • +<li><a href="/articles/calcifying-pulmonary-metastases">calcifying pulmonary metastases</a></li>
  • +<li><a href="/articles/cannonball-metastases-lungs">cannonball pulmonary metastases</a></li>
  • +<li><a href="/articles/cavitating-pulmonary-metastases">cavitating pulmonary metastases</a></li>
  • +<li><a href="/articles/cystic-pulmonary-metastases">cystic pulmonary metastases</a></li>
  • +<li><a href="/articles/haemorrhagic-pulmonary-metastases">haemorrhagic pulmonary metastases</a></li>
  • +<li><a href="/articles/ossifying-pulmonary-metastases">ossifying pulmonary metastases</a></li>
Images Changes:

Image 20 CT (lung window) ( update )

Caption was changed:
Case 19: Breastfrom breast cancer metastasis

Image 21 CT (lung window) ( create )

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