CTICasesIntra-arterial Pulmonary Metastases from Chondrosarcoma
Imaging findings
In a patient with prior scapular chondrosarcoma (originally an enchondroma that recurred as a grade-two chondrosarcoma), current chest CT shows numerous pulmonary metastases with a striking hairy, branching intravascular growth pattern. On soft-tissue windows the metastatic tissue is seen filling and growing along the pulmonary arteries bilaterally, more pronounced on the right, forming a coronal image of vascular casts of tumor. A prior study from about two years earlier showed predominantly small peripheral nodules.
Key takeaways
The serial imaging suggests these metastases lodge peripherally in the pulmonary arterial tree, interrupt flow, and then grow retrograde and centrally, filling the arterial lumen rather than arriving as large venous tumor emboli, since there was no venous access route as can occur with renal, hepatic, or adrenal malignancies. This produces one of the most florid examples of intra-arterial tumor spread, and recognizing the vascular-cast morphology is key to distinguishing tumor growth along arteries from typical hematogenous nodules.
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