Clinical scenario: A 30-year-old male presented with a history of shortness of breath of one-day duration. He denied a history of fever, PND, orthopnea or palpitations.
On examination, the patient was conscious, oriented hemodynamically stable.
There was no mediastinal shift and chest was moving equally with respiration. There were scattered crackles heard bilaterally on auscultation.CVS and Abdomen exam was normal
One year before the current presentation, he had noticed painful swelling of his right testis. He had consulted a doctor but didn't follow the advice.
An X-ray chest in ER taken is shown below suggestive of canon ball shadows.
There was a hard firm swelling in the right testis and an Ultrasound of the testis showed diffuse hypoechoic mass suggestive of a neoplastic lesion
Cannonball metastases:
Multiple well-defined lesions in both lungs are called cannonball metastases due to their large, round appearance.
This pattern is the common manifestation of metastatic disease. The rich vascular bed of the lungs is hospitable to tumor emboli. In some patient, however, a history of primary cancer is lacking at initial presentation. Such a sole presentation of cannonball metastases is classically seen in germ cell tumor, choriocarcinoma, and endometrial cancer.
It is noteworthy that these cancers are sometimes described as human chorionic gonadotropin (hCG) expressing tumors as well. Other than pregnancy, hCG may also be secreted abnormally by certain tumors, particularly in gestational trophoblastic diseases, germ cell tumors, pathological growths of the bladder, uterus, testicular and epithelial cancers.
Other causes are :
renal cell carcinoma
less common primary tumors:prostate carcinoma,synovial sarcoma, endometrial carcinoma also may present as canonballs
