CTICasesEndovascular Pulmonary Metastases from Renal Cell Carcinoma
Imaging findings
CT angiography shows multiple lobulated, heterogeneous filling defects within the segmental and lobar pulmonary arteries, which demonstrate slowly progressive growth on serial scans and internal hypervascular channels/blood flow on coronal reconstructions, in a patient with known renal cell carcinoma.
Key takeaways
Renal cell carcinoma has a strong propensity for hematogenous spread and can cause endovascular pulmonary arterial metastases. These metastases must be distinguished from bland pulmonary emboli, as they do not respond to anticoagulation. Features favoring tumor emboli include progressive growth, expansion of the vessel caliber, and internal contrast enhancement reflecting tumor vascularity.
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