Pulmonary Conditions Mimicking Metastasis: Two Case Reports and Literature Review

Abstract

Pulmonary metastasis usually presents itself as multiple and bilateral nodules with peripheral distribution. The presence of multiple pulmonary nodules in an asymptomatic patient is a situation that frequently leads to a difficult clinical investigation even to experienced physicians. Although metastatic disease is the most important diagnose to be considered in this situation, several diseases can lead to similar radiological images such as granulomas, sarcoidosis, Wegener granulomatosis, benign neoplasm, rheumatoid arthritis, Churg-Strauss syndrome and multiple hamartomas. We present two cases of asymptomatic patients with different diseases, both incidentally discovered, presenting bilateral pulmonary nodules mimicking metastases. One diagnosis was pulmonary lymphangioleiomyomatosis and has been treated with tamoxifen 20mg/day for one year and four months with no lesion progression. The other one was diagnosed as Wegener Granulomatosis and has been treated with corticoid, cyclofosfamide and azatioprin, remaining with one residual calcified node.