CTICasesIntravascular Pulmonary Metastases
Imaging findings
Chest CT in a patient with metastatic colon cancer shows extensive nodular and beaded metastatic deposits lining the interlobar fissures. High-resolution CT also shows multiple small, branching, and lobulated nodular opacities centered on the terminations of subsegmental pulmonary artery branches, representing intravascular tumor emboli/metastases that show progressive growth on serial scans.
Key takeaways
Intravascular pulmonary metastases (tumor emboli) occur when tumor cells lodge and grow within the pulmonary arterial microvasculature. It most commonly arises from mucin-producing adenocarcinomas (e.g., breast, stomach, colon). On CT, it presents as a distinct, branching, or 'knobby' vascular appearance that can mimic a tree-in-bud pattern or vasculitis, and can be associated with extensive pleural metastases along the fissures.
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