CTICasesEndovascular Pulmonary Metastases (Hairy Caterpillar Sign)
Imaging findings
Chest CT shows a primary lung adenocarcinoma with tumor growing along the bronchovascular bundle. Distally, there are bizarre, engorged pulmonary veins containing endovascular tumor metastases. These vessels display a "hairy caterpillar" appearance due to numerous tiny, tumor-packed venous side branches that drain into the main branch.
Key takeaways
Endovascular pulmonary metastases can involve the venous system, leading to tumor thromboembolism or intravascular growth. The "hairy caterpillar" sign is an imaging manifestation of tumor-engorged venous branches, which can be distinguished from arterial metastatic patterns by their distribution and anatomy on high-resolution MIP reformats.
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