Cheerios Floating on Lung Computed Tomography Scan Revealing Cholangiocarcinoma of the Lungs

Radiologic findings are important in narrowing differential diagnosis. This becomes imperative in unusual presentation of diseases. An uncommon finding on lung imaging is Cheerios signs. It is described as lesions with hypodense center and noticeable rim. These lesions are associated with bronchioloalveolar carcinoma representing lepidic growth. We present a case of rapidly worsening shortness breath and cough. Initial computed tomography scan of the chest showed cystic lesions on ground glass background in both lungs. Extensive workup for inflammatory, infectious, or connective tissue disorders was unremarkable. The biopsy of lung lesions pointed at lung metastasis of cholangiocarcinoma. Our case focuses on the benefit of imaging findings, as metastatic lesions can mimic the presentation of that of other lung diseases.