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SA Journal of Radiology

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The radiological appearance of metastatic cystic lesions

P Barnardt, J du Toit

Abstract


Introduction. Cystic and cavitatory pulmonary lesions are abnormalities encountered on chest computed tomography (CT). Malignant lesions, including metastases, rarely present as cystic lesions; we report on two such cases: a man with advanced carcinoma of the left testis, and a woman with epithelioid trophoblastic tumour.
Discussion. The lungs are the most common site for metastases from non-pulmonary neoplasms. The appearance of cystic lesions in the lung in malignancy is rare and predisposes to spontaneous pneumothoraces. Multiple cystic lesions occur commonly in bronchus carcinoma and also sarcoma, bladder cancer and, less commonly, lymphoma and metastasis. Both chemotherapy and immune suppression can induce cavitation in malignant lesions. Tumour necrosis and tumour infiltration of air-containing spaces with a check-valve mechanism are postulated for causing these cystic lesions. Spontaneous resolution is the rule. Close follow-up is recommended as these spaces may become infected.
Conclusion. CT is the mainstay of diagnostic imaging in cancer patients. Cystic lung lesions are caused by a diverse array of pathological processes, and are rare in metastatic disease.



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