Bilateral pulmonary parenchymal metastasis from a low-grade appendiceal mucinous neoplasm

Low-grade appendiceal mucinous neoplasms, are the most common precursor lesions to pseudomyxomatous peritonei. They are relatively indolent in nature, with a "pushing" style of invasion. We present a case of a 50-year-old gentlemen who underwent staged video assisted thoracoscopic surgery for bilateral pulmonary metastasis secondary to a low-grade appendiceal mucinous neoplasm that had been resected 12 years prior. We highlight the under recognized rare etiology of distant metastasis without evidence of local spread, and therefore whether imaging of the chest should be considered as part of the surveillance protocol.