Lung metastases, portacath

Whenever you’re shown a chest x-ray with a portacath (the circular density projected over the right chest, connected to a tunnelled right internal jugular venous line – note the access needle in-situ, projected over the port), it should prompt you to look for evidence of underlying malignancy or metastatic disease. In this case, there are multiple subtle lung nodules (arrows), which all represent metastases from this patient’s rectal cancer. Other potential sites of metastatic disease on a chest x-ray: pleura (beware the unilateral pleural effusion), hilar/mediastinal lymph nodes, bones (ribs/clavicles/shoulders).