Presentation
Metastatic colorectal cancer. New pleuritic chest pain.
Patient Data
There are bilateral filling defects within the pulmonary arterial tree consistent with acute pulmonary emboli, including within the right middle lobe lobar branch, medial basal right lower lobe segmental branch, and anterobasal and posterobasal left lower lobe branches.
Bilateral solid, rounded pulmonary nodules and masses are in keeping with pulmonary metastases. The larges mass is in the right lower lobe. Left lower paratracheal lymphadenopathy.
Mixed dense and ground glass consolidation in the left upper lobe apical and anterior segments is most in keeping with superimposed pneumonia, however a concurrent underlying neoplastic lesion is not excluded.
Case Discussion
Malignancy is a risk factor for venous thrombosis subsequent pulmonary emboli due to the associated paraneoplastic hypercoagulability. In addition, patients with cancer are at greater risk of developing infections due to the immunosuppressive effects of their treatment regimes or of the malignancy itself.
Pulmonary emboli can be found incidentally in patients with malignancy on diagnostic CT studies performed for other indications, e.g. a restaging study. The pulmonary vascular should be considered a review area when reading scans performed in patients with known or suspected cancer.
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