CTICasesUnilateral Pleural Metastasis from Osteosarcoma
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Imaging findings
Chest radiograph and CT show a massive, unilateral, rind-like calcification along the right pleural space. On CT, the calcific thickening is thick, fuzzy, and ill-defined, showing local growth into the adjacent soft tissues and the central canal of the spine. Comparison with prior CT imaging demonstrates a significant progressive increase in the extent of calcification over several years. A bone scan shows intense radiotracer uptake within the calcified pleural mass and reveals the absence of the right leg, which was previously amputated due to a destructive primary osteosarcoma.
Key takeaways
Unilateral, calcified pleural disease in a young patient can mimic benign fibrothorax, chronic empyema, or trauma sequelae. However, progressive calcification with soft tissue or spinal canal invasion should raise immediate concern for malignant osteosarcoma metastasis. Osteosarcoma can occasionally present with pleural metastases as the sole site of thoracic recurrence without any parenchymal lung nodules, and bone scintigraphy is a highly useful adjunct to demonstrate intense mineral activity in these metastatic sites.
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