PED Case 8: Osteosarcoma metastases

Zhongxia Hu, MD

URMC Department of Imaging

Publication Date: 20170629

History

Patient is a 14-year-old male with history of left tibia osteosarcoma (diagnosed 2 ½ years ago) status post above the left knee amputation. He had a relapse 10 months ago, with known metastases to lung and spine, status post debulking and laminectomy, ICE chemotherapy and radiation therapy to lumbosacral spine. At a recent hematology visit he had a chest x-ray for cough and rhinorrea which revealed a pneumothorax.

Diagnosis

Osteosarcoma metastases

DDx

• Metastasis: most likely given the appearance of the lesion (multiple round nodules, rapidly enlarging).

• Other differential possible, given atypical time course (rapid enlargement in a month).

– Fungal infection

– TB infection

– Granulomatosis with polyangitis

Discussion

• Osteosarcoma metastases often ossify and favor the lung. Classically known to cause pneumothorax

• Most common pediatric primary malignancy with pulmonary metastasies:

– Rhabdomyosarcoma

– Osteosarcoma

– Wilm’s tumor

– Ewing’s sarcoma

Comments

References

  1. Radiopedia
  2. Uptodate
  3. Core Radiology

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