CTICasesSuperinfected Metastasis (Aspergillus) with Fatal Bronchial Artery Hemorrhage
Imaging findings
A patient with head and neck cancer developed multiple bilateral cavitary pulmonary nodules over a year. Biopsy of one lesion resulted in pneumothorax and hemorrhage. Several hours post-procedure, the patient experienced massive hemoptysis and died. Autopsy revealed a large cavitary metastatic lesion (from head and neck cancer) located along a bronchovascular bundle, superinfected with Aspergillus, and a ruptured bronchial artery within the lesion. Most other cavitary nodules showed only tumor necrosis.
Key takeaways
Pulmonary metastases, particularly cavitary ones, can become superinfected (e.g., with Aspergillus), leading to conditions resembling chronic necrotizing or semi-invasive aspergillosis. Such lesions, especially those involving bronchovascular bundles, carry a risk of spontaneous, massive bronchial artery hemorrhage, which can be fatal. This case emphasizes the importance of considering infection in cavitary lesions even with high clinical suspicion for metastatic disease, and that delayed hemoptysis may not always be procedure-related.
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