Computed tomography aspects of thoracic metastases from osteosarcoma: pictorial essay

Osteosarcoma is the most common primary bone tumor, with a higher incidence in the second decade of life, and it often leads to pulmonary metastases. The most common pattern seen on computed tomography is one of multiple well-defined nodules in the lung parenchyma, often with calcifications. Because of the variety of presentations of pulmonary metastases in osteosarcoma, including atypical forms, knowledge of the computed tomography aspects of these lesions is important for characterizing and evaluating the extent of the disease, as well as for distinguishing metastatic disease from other benign or malignant lung diseases. This essay discusses the main tomographic findings of pulmonary metastases from osteosarcoma.

Keywords:
Neoplasm metastasis; Lung neoplasms/secondary; Osteosarcoma/secondary; Tomography; X-ray computed

Authorship

Jéssica Albuquerque M. Silva

Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, BrazilInstituto Nacional de CâncerBrazilRio de Janeiro, RJ, BrazilInstituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0003-0616-982X

Bruno Hochhegger

University of Florida, Gainesville, FL, USAUniversity of FloridaUSAGainesville, FL, USAUniversity of Florida, Gainesville, FL, USA

http://orcid.org/0000-0003-1984-4636

Viviane Brandão Amorim

Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, BrazilInstituto Nacional de CâncerBrazilRio de Janeiro, RJ, BrazilInstituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0002-2841-9028

Gláucia Zanetti

Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, BrazilUniversidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil

http://orcid.org/0000-0003-0261-1860

Edson Marchiori Correspondence: Dr. Edson Marchiori. Rua Thomaz Cameron, 438, Valparaiso. Petrópolis, RJ, Brazil, 25685-120. Email: edmarchiori@gmail.com.

http://orcid.org/0000-0001-8797-7380

Correspondence: Dr. Edson Marchiori. Rua Thomaz Cameron, 438, Valparaiso. Petrópolis, RJ, Brazil, 25685-120. Email: edmarchiori@gmail.com.

SCIMAGO INSTITUTIONS RANKINGS

Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, BrazilInstituto Nacional de CâncerBrazilRio de Janeiro, RJ, BrazilInstituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil

University of Florida, Gainesville, FL, USAUniversity of FloridaUSAGainesville, FL, USAUniversity of Florida, Gainesville, FL, USA

Figures

Figures (11)

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Figure 1
Nodular metastases in a 72-year-old woman with a primary osteosarcoma of the femur. Axial CT slices with a lung window (A) and a mediastinal window (B), showing multiple nodules of varying sizes in both lungs, the largest nodule being in the right lung and containing foci of calcification.

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Figure 2
Masses in a 16-year-old male patient with a primary osteosarcoma of the tibia. Axial and coronal CT slices (A and B, respectively) with a mediastinal window, showing bilateral masses in the lower lobes, with foci of calcification on the left.

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Figure 3
Calcified nodular metastases in a 15-year-old male patient with a primary osteosarcoma of the femur. Axial CT slices with a lung window (A) and a mediastinal window (B), together with a coronal CT slice with a mediastinal window (C), showing multiple calcified nodules in both lungs. The metastases were diagnosed by biopsy, and the patient evolved to death in eight months.

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Figure 4
Calcified metastases in a 14-year-old male patient with a primary osteosarcoma of the femur. Axial CT slices with a lung window (A) and a mediastinal window (B), together with a coronal CT slice with a mediastinal window (C), showing calcified masses and nodules in both lungs, with a reduction in the volume of the right lower lobe.

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Figure 5
Cavitary metastases with pneumothorax in a 16-year-old male patient with a primary osteosarcoma of the femur. Coronal CT scan with a lung window, acquired at the time of diagnosis, showing multiple cavitary lung lesions together with bilateral pneumothorax.

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Figure 6
Hemorrhagic metastasis in a 16-year-old male patient with a primary osteosarcoma of the femur. Axial CT slice with a lung window, showing nodular opacity, surrounded by ground-glass opacities, in the left lower lobe, suggestive of hemorrhage.

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Figure 7
Vascular metastases in a 7-year-old boy with a primary osteosarcoma of the femur. Coronal CT slices with a lung window (A) and a mediastinal window (B), showing bilateral calcified intravascular pulmonary metastases in the descending branches of the pulmonary arteries, confirmed by biopsy.

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Figure 8
Intravascular metastases in a 15-year-old male patient with a primary osteosarcoma of the tibia. Sagittal CT reconstruction showing calcified opacities with a tree-in-bud pattern in the right lower lobe.

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Figure 9
Tumor dissemination via the lymphatic system in a 14-year-old female patient with a primary osteosarcoma of the femur. CT, with a mediastinal window, of the upper and lower lung fields (A and B, respectively), showing several calcified nodules in the subpleural regions and along the fissures. Note also the mediastinal lymph node calcifications and pericardial effusion.

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Figure 10
Lymph node metastases in a 13-year-old female patient with a primary osteosarcoma of the tibia. Axial CT scan with a mediastinal window, showing a mass with foci of calcification in the left lung, along with a large mass with coarse calcification in the subcarinal region, corresponding to enlarged calcified lymph nodes.

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Figure 11
Pleural metastases in a 16-year-old female patient with a primary osteosarcoma of the tibia. Axial CT slice (A) showing small nodules and calcified pleural plaques on the left. Axial CT slice acquired one month later (B) showing substantial worsening of the disease, with complete opacification of the left hemithorax caused by a large heterogeneous mass, together with pleural thickening and calcification, which occupies the entire pleural cavity, as well as a mass with calcification on the right.

Figure 1 Nodular metastases in a 72-year-old woman with a primary osteosarcoma of the femur. Axial CT slices with a lung window (A) and a mediastinal window (B), showing multiple nodules of varying sizes in both lungs, the largest nodule being in the right lung and containing foci of calcification.

Figure 2 Masses in a 16-year-old male patient with a primary osteosarcoma of the tibia. Axial and coronal CT slices (A and B, respectively) with a mediastinal window, showing bilateral masses in the lower lobes, with foci of calcification on the left.

Figure 3 Calcified nodular metastases in a 15-year-old male patient with a primary osteosarcoma of the femur. Axial CT slices with a lung window (A) and a mediastinal window (B), together with a coronal CT slice with a mediastinal window (C), showing multiple calcified nodules in both lungs. The metastases were diagnosed by biopsy, and the patient evolved to death in eight months.

Figure 4 Calcified metastases in a 14-year-old male patient with a primary osteosarcoma of the femur. Axial CT slices with a lung window (A) and a mediastinal window (B), together with a coronal CT slice with a mediastinal window (C), showing calcified masses and nodules in both lungs, with a reduction in the volume of the right lower lobe.

Figure 5 Cavitary metastases with pneumothorax in a 16-year-old male patient with a primary osteosarcoma of the femur. Coronal CT scan with a lung window, acquired at the time of diagnosis, showing multiple cavitary lung lesions together with bilateral pneumothorax.

Figure 6 Hemorrhagic metastasis in a 16-year-old male patient with a primary osteosarcoma of the femur. Axial CT slice with a lung window, showing nodular opacity, surrounded by ground-glass opacities, in the left lower lobe, suggestive of hemorrhage.

Figure 7 Vascular metastases in a 7-year-old boy with a primary osteosarcoma of the femur. Coronal CT slices with a lung window (A) and a mediastinal window (B), showing bilateral calcified intravascular pulmonary metastases in the descending branches of the pulmonary arteries, confirmed by biopsy.

Figure 8 Intravascular metastases in a 15-year-old male patient with a primary osteosarcoma of the tibia. Sagittal CT reconstruction showing calcified opacities with a tree-in-bud pattern in the right lower lobe.

Figure 9 Tumor dissemination via the lymphatic system in a 14-year-old female patient with a primary osteosarcoma of the femur. CT, with a mediastinal window, of the upper and lower lung fields (A and B, respectively), showing several calcified nodules in the subpleural regions and along the fissures. Note also the mediastinal lymph node calcifications and pericardial effusion.

Figure 10 Lymph node metastases in a 13-year-old female patient with a primary osteosarcoma of the tibia. Axial CT scan with a mediastinal window, showing a mass with foci of calcification in the left lung, along with a large mass with coarse calcification in the subcarinal region, corresponding to enlarged calcified lymph nodes.

Figure 11 Pleural metastases in a 16-year-old female patient with a primary osteosarcoma of the tibia. Axial CT slice (A) showing small nodules and calcified pleural plaques on the left. Axial CT slice acquired one month later (B) showing substantial worsening of the disease, with complete opacification of the left hemithorax caused by a large heterogeneous mass, together with pleural thickening and calcification, which occupies the entire pleural cavity, as well as a mass with calcification on the right.

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Computed tomography aspects of thoracic metastases from osteosarcoma: pictorial essay

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[1] Correspondence: Dr. Edson Marchiori. Rua Thomaz Cameron, 438, Valparaiso. Petrópolis, RJ, Brazil, 25685-120. Email: edmarchiori@gmail.com.