CTICasesDiffuse Miliary Pulmonary Metastases from Papillary Thyroid Carcinoma
Imaging findings
A patient with papillary thyroid carcinoma had CT showing innumerable tiny scattered pulmonary nodules that were easily overlooked on routine scrolling but were dramatically demonstrated using maximum intensity projection (MIP) reconstructions, revealing a true miliary pattern of metastatic disease. A contemporaneous radioiodine (I-131) planar and SPECT study showed intense, diffuse pulmonary uptake corresponding to the innumerable sub-CT-resolution metastatic deposits, one of the most striking examples of pulmonary radioiodine avidity encountered.
Key takeaways
Papillary thyroid carcinoma is a recognized cause of a miliary pulmonary metastatic pattern that can be subtle on standard CT windows and is best appreciated with MIP reconstructions, and correlating with radioiodine uptake imaging can confirm that innumerable tiny nodules below the resolution of CT represent the aggregate burden of metastatic disease.
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