Few tiny fissural nodules are noted bilaterally with a tiny random nodule measuring ~ 2.4mm in the upper lingula with feding vessel. Another tiny nodule is seen in the posterior segment of Trace centriacinar emphysema is seen in bilateral upper lobes. Rest of bilateral lung parenchyma is normal with normal bronchovascular markings. No focal consolidation is seen. Trachea and bilateral mainstem bronchi are normal. Heart is normal in size and morphology. No pericardial effusion is seen. Atheromatous calcifications ar seen in aortic wall and coronary vessels No evidence of pleural effusion. Mild pleural thickening is seen on right side. Subcentimetric to centimeter sized lymph nodes are seen in the right paratracheal and subcarinal location, largest measuring ~ 10mm in subcarinal location. Minimally displaced healing fracture of left 7* rib is seen with surrounding callus formation. Degenerative changes are seen in visualised spine. Chemoport is seen in situ. IMPRESSION: In this k/c/o of metastatic carcinoma pancreas, present scan reveals , Few tiny fissural nodules bilaterally with tiny random nodules in the superior lingula, right upper lobe. , Trace centriacinar emphysema. compared to the previous PET-CT study dated 17/01/2026, there is minimal reduction in size of the lingular nodule. Rest of the findings are unchanged. No new nodules are seen. Suggested follow up and clinical correlation.
pulmonary nodules metastatic pancreatic cancer CT findings
CT chest pulmonary nodule feeding vessel metastatic pancreatic cancer management 2025
CT Chest Report - Clinical Interpretation
Key Findings - Broken Down
1. Pulmonary Nodules (Most Clinically Significant)
| Finding | Detail |
|---|---|
| Fissural nodules | Few, bilateral, tiny - likely pleural/subpleural metastatic deposits |
| Superior lingula nodule | ~2.4 mm, random distribution, with feeding vessel sign |
| Right upper lobe nodule | Posterior segment - size not fully stated in the report |
| Change from prior PET-CT (17/01/2026) | Minimal reduction in lingular nodule; no new nodules |
2. Mediastinal Lymph Nodes
- Right paratracheal and subcarinal nodes: subcentimetric to ~10 mm
- A 10 mm subcarinal node is at the upper limit of normal by size criteria (typically <10 mm short axis for mediastinal nodes)
- In the context of known metastatic pancreatic cancer, these nodes are suspicious for metastatic involvement, though they were present on the prior study (unchanged)
3. Mild Right-Sided Pleural Thickening
- No pleural effusion - a reassuring finding
- Mild pleural thickening on the right: could reflect prior pleural involvement, reactive change, or early pleural metastasis. Needs monitoring.
4. Cardiovascular Findings
- Atheromatous calcifications in the aortic wall and coronary vessels - indicates established atherosclerotic disease, clinically relevant for treatment planning (cardiotoxicity risk with certain regimens)
- Normal cardiac size and morphology, no pericardial effusion
5. Centriacinar Emphysema (Trace, Bilateral Upper Lobes)
- Mild, trace - likely smoking-related background change
- Not treatment-related; of limited immediate clinical significance but relevant to baseline pulmonary reserve
6. Left 7th Rib - Healing Fracture
- "Minimally displaced healing fracture with callus formation" - this is an important incidental finding
- In metastatic pancreatic cancer, rib fractures may be:
- Spontaneous/pathological (from bone metastasis) - though callus formation and healing suggest a stress/traumatic fracture that is resolving
- Treatment-related (osteopenia from steroids, nutritional deficiency)
- Traumatic
- The presence of callus is reassuring that healing is progressing. However, bone metastases should be excluded if not already evaluated on the prior PET-CT.
7. Degenerative Spinal Changes
- Expected age/disease-related finding; no new aggressive lesions mentioned.
8. Chemoport In Situ
- Confirms active systemic treatment (chemotherapy ongoing).
Overall Clinical Impression - Summary
| Category | Status |
|---|---|
| Pulmonary metastases | Stable to mildly improving (lingular nodule slightly smaller) |
| New pulmonary lesions | None |
| Mediastinal nodes | Stable, borderline subcarinal node |
| Pleural disease | Mild right-sided thickening, no effusion |
| Cardiac | Normal; atherosclerosis noted |
| Osseous | Healing left 7th rib fracture (evaluate for pathological vs. traumatic cause) |
| Emphysema | Trace, clinically minor |
Clinical Recommendations / Points for Correlation
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Response assessment: The minimal reduction in the lingular nodule with no new nodules represents stable disease with marginal response - generally interpreted as disease control on the current regimen. Continuation of current chemotherapy is supported.
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Follow-up CT: The radiologist recommends follow-up with clinical correlation - typically a repeat CT chest in 6-8 weeks (or per oncology protocol) is appropriate to confirm nodule stability or further response.
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Left 7th rib fracture: If the prior PET-CT did not show pathological uptake at this site, the fracture is likely traumatic/stress-related and healing well. If bone metastasis was not previously excluded here, a targeted bone scan or review of prior PET images is warranted.
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CA 19-9 correlation: Serial tumor marker levels should be correlated with imaging to assess overall treatment response.
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Atherosclerotic disease: Note cardiovascular comorbidity for chemotherapy cardiotoxicity monitoring.
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Pleural thickening: Monitor for progression on subsequent scans - if it increases or an effusion develops, cytological sampling may be needed.
Note: Pulmonary metastases in pancreatic cancer, even when small and oligometastatic, indicate stage IV disease. However, recent data suggests that isolated pulmonary-only metastases may carry a slightly better prognosis than liver or peritoneal metastases, and continued systemic therapy is appropriate. The feeding vessel sign and random nodule distribution are consistent with hematogenous spread, as expected in this clinical setting. (PMC - Imaging of Pulmonary Metastases)