CTICasesMiliary Metastatic Papillary Thyroid Cancer
Imaging findings
A radiograph from 2011 demonstrates very fine, almost miliary micronodules, predominantly located in the lower lobes, which are more apparent on the lateral view. Subtle tracheal deviation to the left is also noted. A CT scan performed two years later (following thyroidectomy) reveals larger nodules in the upper lobes and extensive miliary metastatic disease originating from papillary thyroid cancer, with a striking gravitational-dependent distribution in the lower lobes. A more recent CT scan (one month prior) shows confluent consolidation, simulating pneumonia, representing the progression to confluent metastatic disease.
Key takeaways
Miliary metastatic disease from papillary thyroid cancer can manifest as finely nodular opacities, often with a gravitational-dependent distribution. Tracheal deviation can serve as a subtle indicator of underlying thyroid pathology. The pattern of disease can evolve from discrete miliary nodules to confluent consolidation, underscoring the importance of differentiating between nodular and reticular patterns.
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