Imaging of Metastases in the Chest: Mechanisms of Spread and Potential Pitfalls

Pulmonary and pleural metastases are routinely identified on thoracic computed tomography. Pulmonary metastases are the most common pulmonary neoplasms and commonly originate from primary malignancies of the lung, breast, colon, pancreas, stomach, skin (ie, melanoma), head and neck, and kidney. Metastatic disease to the lungs may occur via 3 routes of spread: hematogenous, lymphatic, and endobronchial. Pleural metastases most commonly originate from primary malignancies of the lung and breast. Mechanisms of pleural metastatic involvement include hematogenous spread, direct invasion from a neighboring tumor, and retrograde lymphatic spread from the mediastinum. Awareness of the spectrum of appearances of metatastic disease in the chest is important in avoiding misinterpretation.