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138 Chapter 3: Respiratory system

Aetiology Investigations
The site of primary is usually the kidney, prostate, breast, Identification is by chest X-ray usually appearing as
bone, gastrointestinal tract, cervix or ovary. round shadow(s) 1.5–3 cm in diameter. CT scan shows
up smaller metastases in most cases. Renal tumour
Pathophysiology metastases may present as a solitary round shadow. In
Secondary tumours nearly always develop in the lung lymphangitis carcinomatosa there is characteristically
parenchyma where they cause little or no symptoms. bilateral lymphadenopathy with dilated intrapulmonary
Carcinoma, particularly of the stomach, pancreas or lymphatic vessels appearing as streaky shadowing over
breast can spread via the pulmonary lymphatic vessels both lung fields emanating from the hilar regions.
causing a syndrome of lymphangitis carcinomatosa.
Management
Clinical features Truly single metastases can be removed surgically, but
Usually asymptomatic, it is usually found as part of the this is uncommon.
screening of a patient with known malignancy. Rarely
cause chest pain, haemoptysis or breathlessness (the last Prognosis
suggests lymphangitis carcinomatosa). Lymphangitis carcinomatosa is rapidly fatal.