Asymptomatic 'Cannonballs' in the Lungs

September 14, 2005
Samer Alkhuja, MD

A 49-year-old woman, severely obese but otherwise healthy, appeared for a preemployment medical examination. She neither smoked cigarettes nor drank alcohol. She had no respiratory problems and recalled no family history of such. A baseline mammogram taken 4 years earlier showed no abnormalities, and the patient was not under care for any medical condition. Results of physical examination were normal, except for the obesity-which made it difficult to determine breast masses with confidence.

A 49-year-old woman, severely obese but otherwise healthy, appeared for a preemployment medical examination. She neither smoked cigarettes nor drank alcohol. She had no respiratory problems and recalled no family history of such. A baseline mammogram taken 4 years earlier showed no abnormalities, and the patient was not under care for any medical condition. Results of physical examination were normal, except for the obesity-which made it difficult to determine breast masses with confidence.

Routine posteroanterior (A) and lateral (B) chest films showed “cannonballs.” This, writes Dr Samer Alkhuja of Greenwich, Conn, is a radiologic term for multiple large, well-defined, nodular shadowing in the lungs. A mammogram (C) revealed a large mass in the left breast, a needle biopsy of which showed an estrogen-receptor–negative, infiltrating, ductal carcinoma. The patient was given chemotherapy, but she died 2 months later.

The differential diagnosis of cannonballs includes neoplastic, infectious, immunologic, vascular, and traumatic masses.1 Dr Alkhuja emphasizes the importance of encouraging women to return for screening mammograms at whatever intervals are recommended, depending on their age and history.2

REFERENCES:
1.
Chapman S. Cannonballs. Br J Hosp Med. 1992;48:263-264.
2. Schapira DV, Kumar NB, Clark RA, Yag C. Mammography screening credit card and compliance. Cancer. 1992;70:509-512.

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