CTICasesPulmonary Metastases from Angiosarcoma Presenting as Recurrent Hemorrhage
[...]. Pulmonary Metastases from Angiosarcoma Presenting as Recurrent Hemorrhage. CTICases. Published September 11, 2026. https://cticases.com/c/u8d2g
Imaging findings
A patient presented with recurrent hemoptysis over several weeks. The initial CT showed extensive ground glass abnormality with an intralobular gradient on several images and layering of opacity against the fissure, the appearance of liquid settling within the lobules and entirely compatible with pulmonary hemorrhage. Serial radiographs and CTs over the following months waxed and waned as the lungs filled with blood and cleared. On the studies with least generalized ground glass, discrete lesions emerged: nodules, one with a small cavity, many of them surrounded by a ground glass halo, and at least one dense nodule with adjacent ground glass. The pattern was recognized as pulmonary metastases from an angiosarcoma of the face, the presenter's initial instinct having been a right atrial primary.
Key takeaways
A gravity-dependent gradient within the secondary lobules, with opacity settling against a fissure, indicates liquid drifting through the lung and favors blood or water over infection or diffuse alveolar damage, which do not layer that way. Nodules with ground glass halos prompt consideration of angioinvasive fungal infection and granulomatosis with polyangiitis, but hypervascular metastases produce the same sign. The halo around an angiosarcoma metastasis is probably not hemorrhage at all but a network of neoplastic vascular channels forming part of the tumor, which explains why multiple metastases show identical halos at the same time and why they persist rather than resolving; the same is seen with choriocarcinoma. Those malformed channels leak, producing the recurrent hemoptysis, possibly compounded by thrombocytopenia in vascular tumors. There was no lung biopsy in this case, so the diagnosis rested on the imaging pattern and the known primary.
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