Chapter 9 – Chest

Multiple Lung Nodules


Multiple Pulmonary Nodules


History – This 64 year old female had a nephrectomy for renal cell carcinoma 1 year ago.  She was lost to follow-up.  She was seeing her primary physician for mild chest pain, shortness of breath, and fatigue.

Symptoms – Mild, dull, chest pain.  Weight loss (7 kg in 3 months). Fatigue.

Physical – Nephrectomy scar was seen.  Nil else.


Infection, Pneumonia


Imaging Recommendation

Chest X-ray

ODIN Link for Multiple Pulmonary Nodules images, Figure 9.25:
Figure 9.25 Chest x-ray displaying multiple lung nodules

Imaging Assessment


There were multiple nodules in both lungs of varying sizes.  They were round and well marginated.  No evidence of central necrosis. No evidence of lymphadenopathy. No other findings.


Embolic infection

Embolic malignancy


Metastatic Disease – Renal Cell Carcinoma


Multiple nodules in the lung are most often metastatic lesions that have traveled through the bloodstream from a distant primary (hematogenous spread).  Hematogenous spread of infection may also be possible. Multiple metastatic nodules are usually of differing sizes, varying from micronodular to “cannonball” masses, indicating tumour embolization that occurred at different times. They are frequently sharply marginated.

Possible Tumours of Origin:
Males     Females 
Colorectal carcinoma        Breast cancer
Renal cell carcinoma Colorectal carcinoma
Head and neck tumors Renal cell carcinoma
Testicular and bladder carcinoma Cervical or endometrial carcinoma
Malignant melanoma Malignant melanoma
Sarcomas Sarcomas

Possible Primary Tumours that may result in Lung Metastases, by Gender

X-ray findings may include:

  • Nodules of similar or varying sizes.
  • The patient may be cachectic due to malignancy.
  • The nodules may be smooth or lobulated.
  • There may be cavitation in some types of nodules or masses.


Figure 9.25 Chest x-ray displaying multiple lung nodules by Dr. Brent Burbridge MD, FRCPC, University Medical Imaging Consultants, College of Medicine, University of Saskatchewan is used under a CC-BY-NC-SA 4.0 license.


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Undergraduate Diagnostic Imaging Fundamentals Copyright © 2017 by Brent Burbridge is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.