Pulmonary Cavities Due to Bladder Cancer

Abstract

A 69-year-old male patient with a history of high blood pressure and active smoking. He was diagnosed 11 years ago with localized urothelial bladder cancer with invasion of the lamina propria (T1) and without invasion of the muscularis layer. Multiple local interventions were performed, the last one 5 years ago with disease-free follow-up. He consulted in February of this year for a cervical tumor, a computed tomography scan of the neck was requested, showing an infected thyroglossal cyst and right supraclavicular and lower right paratracheal lymphadenopathy. The study was complemented with a computed tomography scan of the chest, abdomen and pelvis, also revealing bilateral pulmonary cavities with thick walls and irregular internal borders. A biopsy of the right supraclavicular lymph node was performed, which was positive for urothelial carcinoma metastasis. The presence of multiple pulmonary cavitary lesions should raise suspicion of metastasis. Cavitation is estimated to occur in approximately 4% of pulmonary metastases, and is most often caused by squamous cell carcinoma. Rarely, low-grade superficial bladder tumors progress directly to metastatic disease without prior evidence of muscle invasion. The development of cavitary lesions in a patient with transitional cell carcinoma of the bladder should raise suspicion of metastatic disease.