A 65-year-old man presented to the respiratory clinic with 12 kilograms of weight loss over 6 months, lethargy, chronic cough, and bilateral nodular abnormalities on his chest X-ray. He underwent a bronchoscopy. Washings from the bronchoscopy revealed clusters of cells in keeping with an adenocarcinoma.

A computed tomographic (CT) scan of his chest showed a large number of pulmonary nodules scattered throughout the lungs measuring from a few millimetres to a few centimetres. There are associated enlarged mediastinal lymph nodes.

Images from the CT scan are shown below and are characteristic for metastatic adenocarcinoma. CT scan also suggested probable liver metastases.

The primary source has not been identified. Carcinogenic embryonic antigen (CEA) level was raised, which points towards colon carcinoma, though it is non-specific in the setting of metastatic disease. The patient did not wish to undergo further investigations to find the primary source.

Author information: Emily Duncan, Medical Registrar, Department of General Medicine; Lutz Beckert, Respiratory Physician, Department of Respiratory Medicine; Christchurch Hospital, Christchurch

Correspondence: Dr Lutz Beckert, Department of Respiratory Medicine, Christchurch Hospital, PO Box 4345, Christchurch, New Zealand. Fax: +64 (0)3 3640914; email: Lutz.Beckert@cdhb.govt.nz