CTICasesIntravascular Pulmonary Metastases with Infarction
Imaging findings
A patient with bladder cancer has an opacity in the anterior basal segment of the right lower lobe that is partly solid and partly ground-glass, which became more solid on follow-up, with a second focus posteriorly. In retrospect, the lobular pulmonary arteries in these areas are distended compared with adjacent vessels, indicating intravascular metastases growing within lobular arteries and producing enough ischemia to infarct the involved lobules.
Key takeaways
Intravascular pulmonary metastases can grow within lobular arteries, appearing as subtly distended vessels (a vascular tree-in-bud phenomenon), and can rarely cause enough obstruction to infarct the supplied lung, producing an evolving consolidative opacity. Recognizing the enlarged lobular arteries and new opacities in a patient with a known primary suggests this uncommon mechanism.
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