CTICasesMassive Endovascular Metastases from Renal Cell Carcinoma
Imaging findings
In a patient with known renal cell carcinoma, chest CT shows numerous pulmonary nodules, many of which are branching and tubular rather than round, following and dilating vascular structures rather than sitting within the airways; one focus appears to extend into a central airway as well.
Key takeaways
A predominantly branching, vessel-centered pattern of pulmonary nodules -- rather than discrete round nodules -- represents extensive endovascular tumor metastasis, a pattern most classically associated with renal cell carcinoma (also reported with hepatocellular carcinoma and sarcoma); associated ground-glass opacity can reflect focal hemorrhage or hemorrhagic infarction from vessel occlusion by tumor.
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