# Balloon-Release Pattern on the Chest X-ray of a Young Male Patient With Metastatic Testicular Choriocarcinoma: A Case Report of an Aggressive Pulmonary Presentation

## TL;DR

A 24-year-old man with aggressive testicular choriocarcinoma showed a unique 'cannonball' pattern on chest X-ray, emphasizing the need for rapid diagnosis and treatment.

## Contribution

This case report highlights the rare and aggressive pulmonary presentation of metastatic testicular choriocarcinoma in a young male.

## Key findings

- A 'cannonball' pattern of multiple pulmonary nodules was observed on chest X-ray.
- The patient had a large metastatic lesion compressing the left pulmonary artery.
- Urgent chemotherapy was initiated following orchiectomy confirming metastatic choriocarcinoma.

## Abstract

While testicular cancer (TC) is one of the most common malignancies in young men, choriocarcinoma (CC) represents one of the rarest subtypes within this group. CC is a non-spermatogonial germ cell tumor (GCT) with a highly aggressive presentation, requiring prompt and accurate diagnosis and management without delay. We present a case of a 24-year-old male patient who presented to the emergency department with nausea, vomiting, and shortness of breath. Physical examination revealed muscle wasting, fever, and a right testicular mass. A chest X-ray demonstrated a “cannonball” pattern of multiple pulmonary nodules. Chest CT confirmed bilateral pulmonary metastases, with the largest lesion measuring 8×7 cm, causing compression of the left pulmonary artery. An abdominopelvic CT revealed a 6×5 cm right testicular tumor. Further evaluation and orchiectomy confirmed metastatic CC, a rare form of TC. The patient was started on urgent chemotherapy and referred to a tertiary care center. This case highlights the importance of early recognition of aggressive metastatic CC and the need for prompt intervention in TC.