CTICasesOsteosarcoma Pulmonary Metastases with Calcification and Possible Intravascular Growth
Imaging findings
CT demonstrates multiple pulmonary nodules of varying sizes throughout both lungs. A subset of the nodules contains internal calcification or ossification, reflecting the osteoblastic nature of the primary osteosarcoma. A lower lobe right-sided nodule has a branching configuration on both the index CT and follow-up imaging, possibly representing tumor growing within a vessel or a vascular branch containing metastatic tumor. The branching high-attenuation character of this lesion raises the possibility of intravascular metastasis.
Key takeaways
Osteosarcoma pulmonary metastases are characteristically calcified or ossified, reflecting the bone-forming tumor matrix within the metastatic deposits. Recognition of internal calcification within pulmonary nodules in the appropriate clinical context of a known osteosarcoma is diagnostic of metastatic disease. Branching nodular configurations may represent intravascular tumor growth within pulmonary vessels, which osteosarcoma is known to exhibit. The degree of calcification within metastatic deposits correlates with the osteoblastic differentiation of the primary tumor.
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