Cannon ball lesions

Although difficult to reproduce in a web image, at the left base one can see a round lesion.
Most important for the boards is its workup. For its workup you must see Solitary pulmonary nodule . This will be in the exam.

Differential diagnosis for this would be a nipple shadow but there is no such lesion at the corresponding position on the opposite side. One also sees that there is hardly any calcium in the lesion making it very likely to be a malignant lesion. In the actual X-ray film one could see at least 3 more such rounded lesions making it most likely to be metastatic disease to the lungs.

This patient had metastatic adenocarcinoma from the rectum. She had complained about mucus discharge from the rectum to a doctor about a year ago. A complaint like this should trigger a Rectal exam & endoscopic exam of the colon.