case_images: PMC5450457_01
case_images: A 68-year-old male with a history of high-grade invasive urinary bladder carcinoma presented with weight loss and left-sided neck swelling. (a) Chest radiograph (posterior-anterior projection) showed a widened right paratracheal stripe (asterisk). The diaphragmatic contours are flattened, suggesting lung hyperinflation. (b) Chest computed tomography set to soft tissue windows (coronal reconstruction) demonstrates bulky paratracheal and subcarinal lymphadenopathy with areas of hypodensity suggestive of necrosis (arrows). Transbronchial needle aspiration of the right paratracheal lymph node revealed metastatic carcinoma histologically compatible with urothelial origin.
case_images: JCIS-7-23-g003.jpg
case_images: PMC5450457_01_JCIS-7-23-g003.jpg
case_images: F2
case_images: CR showed a widened right paratracheal stripe [Figure 2a]. Computed tomography (CT) of the chest without intravenous contrast demonstrated multicompartment mediastinal lymphadenopathy, including the right lower paratracheal (4R) and subcarinal (7) lymph node stations [Figure 2b].
case_images: PMC5450457_02
case_images: An 85-year-old female with chronic obstructive pulmonary disease and recurrent low-grade papillary urinary bladder carcinoma presented for the evaluation of an abnormal chest radiograph. Axial chest computed tomography set to lung windows reveals both thick-walled (a) and thin-walled (b) cavitary nodules and masses (arrows). Computed tomography-guided needle biopsy of the lesion in panel A showing multiple nests of malignant cells (c, arrows) that stain positive for GATA-3 on immunohistochemistry (d), features consistent with metastatic urothelial carcinoma.
case_images: JCIS-7-23-g004.jpg
case_images: PMC5450457_02_JCIS-7-23-g004.jpg
case_images: F3
case_images: CT revealed numerous cavitary nodules and masses, some with thick [Figure 3a] and others with thin [Figure 3b] walls. CT-guided biopsy of the lesion in Figure 3a was consistent with metastatic urothelial carcinoma [Figure 3c and d].
case_images: PMC5450457_03
case_images: A 54-year-old female with a history of metastatic urinary bladder carcinoma presented with shortness of breath and hypoxemia. (a) Axial chest computed tomography set to soft tissue windows demonstrates bilateral pleural effusions (asterisks) with compressive atelectasis. (b) Cytology from the right pleural effusion demonstrates tumor cells with enlarged nuclei, increased nuclear to cytoplasmic ratio, and irregular nuclear membrane. (c) Immunohistochemistry demonstrates positive staining for GATA-3 and CK903 and negative staining for calretinin and D2-40, a pattern consistent with metastatic urothelial carcinoma.
case_images: JCIS-7-23-g005.jpg
case_images: PMC5450457_03_JCIS-7-23-g005.jpg
case_images: F4
case_images: CT angiography of the chest was performed to exclude pulmonary embolism, which was not present, but the scan demonstrated moderate bilateral pleural effusions with compressive atelectasis [Figure 4a]. The fluid cytology specimen was consistent with metastatic UBC [Figure 4b and c].
case_images: PMC5450457_04
case_images: A 79-year-old female with urinary bladder carcinoma diagnosed and resected 7 months previously presented with shortness of breath and focal right-sided wheezing. (a) Chest radiograph (anterior-posterior projection) showing volume loss in the right hemithorax with rightward tracheal deviation and silhouetting of the right heart border and right diaphragm, suggestive of right lower and right middle lobe collapse. (b) Axial chest computed tomography set to lung windows showing endobronchial disease occluding the bronchus intermedius (arrow). The patient underwent bronchoscopy with endobronchial tumor debulking; pathology was indicative of high-grade high-grade metastatic urothelial carcinoma.
case_images: JCIS-7-23-g006.jpg
case_images: PMC5450457_04_JCIS-7-23-g006.jpg
case_images: F5
case_images: CR which was consistent with right middle and lower lobe atelectasis [Figure 5a]. CT of the chest demonstrated a mass partially occluding the bronchus intermedius, right middle lobe bronchus, and right lower lobe bronchus [Figure 5b].
case_images: PMC5450457_05
case_images: A 47-year-old man with morbid obesity presented for transurethral resection of a bladder mass. Preoperative hypoxemia prompted computed tomography angiography of the chest, which demonstrates multiple filling defects, including in the anterior segmental artery of the left upper lobe (arrow). Treatment with anticoagulation was started and the patient underwent surgical removal of the bladder tumor, which revealed urothelial carcinoma with sarcomatoid features. His postoperative course was complicated by persistent hypoxemia and progression of disease, and the patient ultimately expired. Autopsy findings demonstrated intravascular tumor thrombi identical on microscopic examination to the previously diagnosed tumor.
case_images: JCIS-7-23-g007.jpg
case_images: PMC5450457_05_JCIS-7-23-g007.jpg
case_images: F6
case_images: His initial course was complicated by hypoxia to 94% with an increased arterial-alveolar gradient, prompting CT angiography of the chest which demonstrated filling defects in multiple left- and right-sided segmental arteries [Figure 6].