Cannon ball appearance on radiology in a middle-aged diabetic female

Abstract

Pulmonary tuberculosis is commonly presented as cavitary lesion and infiltrations. It commonly involves upper lobe. Lower lobe involvement is less common. Various atypical presentations of tuberculosis on radiology are reported like mass, solitary nodule, multi lober involvement including lower lobes. Atypical presentations are more commo in patients with immunocompromised conditions like Diabetes Mellitus, anemia, renal failure, liver diseases, HIV infection, malignancy, patients on immunosuppressive therapy. Cannon ball presentation of pulmonary tuberculosis is extremely rare and not so common. Common causes of cannon ball presentation in lung are metastasis, fungal infections, Wegener's grannulomatosis, sarcoidosis, etc. We report here a case of middle year female with diabetes mellitus presented with atypical symptoms with cannon ball appearance on radiology and found to be of tuberculosis in origin. Thus any patients with immunocompromised condition can present with atypical manifestation of tuberculosis either clinically or radiologicaly in high endemic countries for tuberculosis.

Pancreatic cancer presenting with pulmonary cannonball lesions

“…Classically, the term cannonball lesions are used for lung metastasis from a wide variety of causes, however the term has also been used to report skin metastasis in the setting of lung cancer and acquired tufted angioma due to their macroscopic appearance [4] . Pulmonary cannonball lesions have a distinctive radiographic appearance and are characterized by multiple solid, well-circumscribed, parenchymal masses of variable sizes [5] . When associated with metastatic disease, these pulmonary findings are a result of the hematogenous spread of disease to the lungs and representing an advanced stage and is associated with a poor overall survival.…”

“…Pulmonary cannonball metastases are usually seen in renal cell carcinoma, breast carcinoma, choriocarcinoma, endometrial cancer, prostate cancer, and head and neck squamous cell carcinoma [5 , 6] . There are a handful of case reports of other cancers that may present with metastatic cannonball lesions to the lungs which include melanoma, adrenocortical carcinoma, transitional cell carcinoma of the bladder, testicular cancer, and rarely gastric cancer [7 , 8] .…”

“…In our case, the patient presented with shortness of breath and chest pain. Cannonball lesions may also be present in non-neoplastic conditions including fungal infections such as coccidioidomycosis and histoplasmosis, sarcoidosis, granulomatosis with polyangiitis (formerly Wegener's granulomatosis), nocardiosis, hydatid diseases, parasitic infections, rheumatoid disease, and pulmonary tuberculosis [5] . There have also been several reported cases of hemangiomas developing within the lungs, referred to as pulmonary cavernous hemangiomas giving the cannonball-like appearance, and can be misdiagnosed as lung metastases [10] .…”

An extremely rare case of adrenocortical cancer with cannon ball pulmonary metastasis

“…It is largely described that an adrenocortical cancer, a rare disease also called cancer of the adrenal cortex, can be responsible for pulmonary metastases [1][2]. In addition, cannon ball pul-monary metastases have been associated with a wide spectrum of neoplasms [3]. However, this is the first case described in the literature of cannonball lung metastases caused by an adrenocortical tumor in a man.…”

Pure testicular choriocarcinoma Cannonball metastases as a presenting imaging feature: A case report and a review of literature

“…Nonmalignant causes of cannonball appearance may include fungal infections, tuberculosis, Wegener's grannulomatosis, and sarcoidosis. Therefore, a broad diagnostic workup should be conducted [10] .…”