 In about 75 % cases, presents as multiple pulmonary

nodules.
 Also present as solitary pulmonary nodule/ cavitation/
calcification.
 Approximately 3 % of asymptomaticpulmonary
nodules are metastases.
Site
 Usually bilateral, affecting both lungs equally with a
basal predominance.

 They are often peripheral and may be subpleural.

Primary site
May originate at anysite.
The most common

• Breast carcinoma
• Colorectal carcinoma
• Renal cell carcinoma
• Uterine leiomyosarcoma
• Head and neck squamous cell carcinoma
Clinical features
 Cough
 Dyspnea or shortness of breath
 Chest pain
 Haemoptysis
 Hoarseness of voice
 Features of secondary pulmonaryinfection.
Radiological findings
Common Other patterns
 Nodules.  Cavitation

 Calcification

 Pneumonia-like consolidation

 A halo of ground glass opacity.

 Endobronchial

 Cannon-ball metastases

 Miliary metastases

 Lymphangitis carcinomatosa.
Nodules
 May be solitary ormultiple.
 Rounded nodules of variable sizes ranging fromfew
millimeters to few centimeters withwell-defined margin.
 75 % - multiple pulmonary nodules.
 Commonest tumours producing solitary pulm. nodulesare
carcinomas of –
• Colon
• Kidney
• Breast
• Testicular tumours
• Bone sarcomas
• Malignant melanoma.
 Cavitation
 May occur from anysite.

 More common from-

• Squamous
carcinomas from
head & neck
• Sarcomas.
 May be seen afterchemotherapy

 Subpleural cavitation is a recognized

cause of spontaneous pneumothorax.

 Absent fluid levels.

Calcification
 Is seen in somecases.

 Most often in
• Osteogenic sarcoma
• Chondrosarcoma
• Mucinous
adenocarcinoma.
Pneumonia-like consolidation
 Adenocarcinoma metastases may destroyadjacent
lung parenchyma, resulting in pneumonia-like
consolidation.
A halo of ground-glass opacity

 Ground-glass opacity
surrounding a mass ora
nodule which
represents
haemorrhage.

 Seen in
choriocarcinoma &
angiosarcoma.
Cannon-ball metastases

 Commonest primarysites
being
 RCC
 Choriocarcinoma.
Miliary metastases
 Commonest primary sitesare-
 Thyroid carcinoma
 Malignant melanoma
 RCC
 Osteosarcoma
 Pancreatic neoplasms.
Lymphangitis Carcinomatosa

 Results from haematogenous metastases

invading and occluding peripheral pulmonary
lymphatics.

 Commonest primary sitesare

 Lung Breast
 Stomach Pancreas
 Cervix prostate

 Usually bilateral, but lung and breastcancer

may cause unilateral lymphangitis.

 Chest X-ray
 Coarse, linear, reticular and nodular basalshadowing
often with pleural effusions and hilar
lymphadenopathy.
Approaching to the pulmonal
metastases
 Pulmonary metastases –initial finding
 “Unknown Primary”.
 Clinical presentation and clinicalevaluation.

 Chest X-ray
 CT Scan/PET CT scan

 Cytological examination of sputum

 Cytological examination of pleural fluid
 FNAC or excision biopsy of an enlarged
lymph node
 Bronchoscopy- biopsy, bronchoscopic
alveolar lavagecytology.
Cont…
 USG guided FNAC of lesion

 CT guided FNAC of lesion

 Surgical lung biopsy or open lungbiopsy

 HRCT.
Complications
1. Pneumothorax

2. Pleural effusion

3. Lung collapse.
Treatment modalities
 Chemotherapy

 Radiotherapy

 Surgical

 Palliative care.
RONTGEN THORAKS 11/6/19
Foto thoraks, proyeksi AP, posisi supine,
asimetris, inspirasi dan kondisi cukup, hasil :
- Tampak opasitas inhomogen bentuk amorf,
batas tak tegas, tepi ireguler pada proyeksi
hemithorax sinistra
- Tampak opasitas homogen pada aspek
laterobasal hemithorax sinistra yang
melebarkan pleural space sinistra dan
mengaburkan batas kiri jantung
- Tak tampak pelebaran pleural space dextra
- Tampak diafragma dextra licin dan tak
mendatar
- Cor, CTR tak valid dinilai karena tertutup
opasitas
- Sistema tulang yang tervisualisasi intak, tak
tampak lesi litik maupun sklerotik

Kesan:
- Pleuropneumonia sinistra
suspect mixed type pulmonal
metastasis
- Besar cor tak valid dinilai
karena tertutup opasitas
- Tak tampak skeletal
metastasis pada sistema
tulang yang tervisualisasi
Sintesa Stase
Anamnesis: Pasien adalah penderita ca recti sejak 12/1/16, telah menjalani
kemoterapi 8x dan radioterapi 33x selesai 5/12/18. Mengalami BAB hitam,
hingga menyebabkan transfusi berulang.
Pemeriksaan fisik
Konjungtiva pucat (+), melena (+)
Thorax: vesikuler +/+, crackles -/-, rales -/-
Pemeriksaan penunjang
Hb 4,8 mg/dL
Push enteroskopi: pancolitis ulserativa, ileitis ulserativa, multiple ulcus gaster
fundus dan antrum pilorus, antral gastritis erosiva
Ro thorax : Pleuropneumonia sinistra suspect mixed type pulmonal metastasis
Assessment
Colorectal carcinoma curi metastase paru (post kemo radiasi)
Usulan terapi
Perbaikan KU sesuai TS HOM dan Gastro
TERIMA KASIH

MOHON ASUPAN