Cannon ball lung metastases from a previously unreported primary

Abstract

Well defined and large, rounded multiple shadows in lung fields on chest imaging are commonly caused by metastatic cancer and are called cannon ball shadows. A 46-year-old female presented to us with history of thyroid swelling for 10 years. She had been investigated four years back and was handed a diagnosis of colloid goitre. The swelling was neglected and she never underwent surgery. Her present problems were shortness of breath, dysphagia and retrosternal chest pain. Evaluation showed a hard goitre with retrosternal extension [Table/Fig-1]. Chest X-ray and contrast enhanced tomography scan of chest showed multiple cannon-ball lung shadows [Table/Fig-2]. Fine needle aspiration from thyroid nodule and from the lung lesions both showed follicular neoplasm of the thyroid. Patient was referred for total thyroidectomy followed by radioiodine therapy. Total thyroidectomy was done and the histopathology of the same confirmed the diagnosis of follicular carcinoma thyroid.