CTICasesIntravascular Pulmonary Metastases from Osteosarcoma
Imaging findings
A patient with osteosarcoma has pulmonary metastases containing osseous matrix, most numerous in the right lower lobe. On thin sections and MIP images, branching tubular opacities are seen that demonstrate internal hyperattenuation on wider windows, representing intravascular metastases that have grown over about a year. Standard 5 mm sections scrolled quickly were relatively unimpressive.
Key takeaways
Intravascular pulmonary metastases appear as branching tubular opacities with internal hyperattenuation (here mineralized, from osteosarcoma), and are far more conspicuous on MIP images, underscoring the value of MIPs in oncologic imaging. Thin (1 mm) sections remain valuable to correlate small MIP nodules, as some represent benign inspissated intraluminal mucus in small airways rather than true metastases; softer reconstruction kernels make vascular MIPs easier to review.
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