CTICasesOsteosarcoma Metastases from Paget's Disease
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Imaging findings
A chest CT incidentally revealed multiple lung nodules, several with eccentric or amorphous calcification, in a patient with a known history of Paget's disease. Subsequent spine MRI for lower extremity issues showed abnormal signal and soft tissue around the sacrum, consistent with sarcomatous degeneration. The lung nodules were later confirmed to be osteosarcoma metastases.
Key takeaways
In patients with Paget's disease, the development of new bone lesions or soft tissue masses (especially in affected bones) should raise suspicion for sarcomatous degeneration (most commonly osteosarcoma). These sarcomas can metastasize to the lungs, presenting as calcified nodules, which can be mistaken for benign calcified granulomas like histoplasmomas. Clinical history and correlation with other imaging are crucial.
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