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INTRODUCTION:Cannonball metastases refer to well-defined spherical nodules scattered over both lungs, being a classical presentation of hematogenous tumor spreading.1 This usually indicates an advanced stage of the disease with a poor prognosis. We present a rare case of Cannonball Lung metastases as the presenting form of Hodgkin Lymphoma (HL).CASE PRESENTATION: 22-year-old male patient with no significant personal or family history, was admitted to the hospital for hypoxia, tachycardia and profound dyspnea. He described progressive dyspnea, fatigue, and 30 lb weight loss over 4 months. Physical exam revealed left axillary and left supraclavicular lymphadenopathy and left breast palpable masses. To evaluate for hypoxia, a chest X-ray was obtained, revealing multiple pulmonary nodules (Fig 1). A CT chest was obtained, showing several well circumscribed nodules/masses (cannonball appearance) involving the lungs, concerning for metastatic disease. (Fig 2)An ultrasound-guided left axillary Node Biopsy confirmed the diagnosis of Classic Hodgkin Lymphoma, Lymphocyte-Rich Subtype. Further radiographic confirmation with Pet CT classified it as Ann Arbor stage IV disease. He was given combination chemotherapy of ABVD (doxorubicin, bleomycin, vinblastine dacarbazine (DTIC). After six cycles of chemotherapy, imaging displayed dramatic improvement in the Pulmonary nodules, with residual nodules not avid on PET-CT. (Fig.4)

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