The Spread of Chest Tumours to the Abdomen, and some Abdominal Tumours to the Chest - also a consideration of some relevant abdominal conditions in differential diagnosis, particularly of the Liver, Spleen and Pancreas.

Lung and thoracic tumours may spread to the abdomen in three ways via the blood stream, via the lymphatics and by direct extension - either through the diaphragm or openings within it. Blood stream spread is very common, particularly to the liver. Metastases also occur to the adrenals, spleen, pancreas, mesentery or omentum, bowel wall, etc. Retrograde lymphatic flow may occur not only into the cisterna chyli from the thoracic duct, but also via retrocrural and peridiaphragmatic vessels and nodes. In addition lymphatics may pass through the diaphragm at other points. Lymphatics in the inferior pulmonary ligaments may pass to the abdomen without necessarily passing through any intrathoracic lymph nodes. In the 1950s, when most liver disease was unrecognisable radiologically, all one could do was to recognise a large liver, or occasionally note intra-hepatic calcification.