Pulmonary cannonballs and more like never before.

To cite: AlShati MH. Thorax 2014;69:200–201. CASE A 44-year-old man presented to hospital with haemoptysis and progressive dyspnoea. Examination revealed room air oxygen saturation of 91% with diffuse chest crackles, gynaecomastia and hepatosplenomegaly. Scrotal examination was unremarkable. Radiological investigations revealed numerous bilateral pulmonary nodules of variable size (cannonball appearance) (figure 1), gynaecomastia (figure 2A), hepatosplenomegaly and a large retroperitoneal mass (figure 2B). Scrotal ultrasound showed no abnormalities. Simple urine pregnancy testing was positive, and serum levels of β-human chorionic gonadotropin (β-HCG) and α-fetoprotein were markedly elevated. Transbronchial and retroperitoneal biopsies confirmed the diagnosis of metastatic extragonadal choriocarcinoma and prompt chemotherapy was initiated; however, the patient died shortly thereafter from respiratory failure.