CTICasesIntravascular Pulmonary Metastases (Tumor Emboli) from Bladder Cancer
Imaging findings
In a patient with metastatic bladder cancer, comparison chest CTs obtained about two months apart showed dramatic interval development of diffuse, multifocal, multilobar new pulmonary opacities. Many of the new opacities were tubular, following the course of pulmonary vessels with distended, shaggy margins, and small dilated side branches (venules) feeding into otherwise normal-appearing vessels were seen adjacent to the larger lesions, a pattern distinguishing them from airway-centered nodules.
Key takeaways
Rapidly developing tubular, vessel-conforming pulmonary opacities with shaggy or irregular margins, rather than discrete round nodules, should suggest intravascular tumor emboli/intravascular metastatic growth rather than typical hematogenous nodular metastases; associated small dilated venous side branches feeding into the abnormal vessel are a helpful secondary clue, analogous to the bronchiolar filling seen with airway impaction, and reflect upstream vascular tumor obstruction.
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