Rastogi Ruchi, Garg Rachana, Thulkar Sanjay, Bakhshi Sameer, Gupta Ajay
Department of Radiology, All India Institute of Medical Sciences, New Delhi, India 110029.
Pediatr Radiol. 2008 May;38(5):551-8. doi: 10.1007/s00247-007-0735-3. Epub 2008 Feb 2.
Pulmonary metastases are common in osteosarcoma and the most common appearance is of multiple well-defined nodules in the lung parenchyma. However, a variety of atypical locations and presentations of osteosarcoma metastasis can occur in the thorax. We present a review of the thoracic CT findings in 16 patients with histopathologically confirmed osteosarcoma with unusual thoracic manifestations. The 16 patients were selected out of a total 136 patients who received a chest CT scan for osteosarcoma during a period of 3 years in a tertiary care hospital. Unusual imaging findings included a solitary large ossified lung mass, ossified mediastinal and hilar lymph nodes, an esophagomediastinal fistula, lymphangitic carcinomatosis, pulmonary artery tumor emboli, a solitary large pleural deposit along the major fissure, multiple pleural deposits, diffuse pleural calcification, pneumothorax, diaphragmatic deposits, an isolated chest wall deposit without lung involvement, and primary osteosarcoma of the rib. Our findings of lymphangitic carcinomatosis in a living patient as well as calcified mediastinal lymphadenopathy leading to esophageal fistula are unique in the literature, and there are only a few case reports of our other findings.
肺转移在骨肉瘤中很常见，最常见的表现是肺实质内多个边界清晰的结节。然而，骨肉瘤转移在胸部可出现各种非典型的部位和表现。我们对16例经组织病理学证实的骨肉瘤且有不寻常胸部表现的患者的胸部CT结果进行了综述。这16例患者是从一家三级医院在3年期间因骨肉瘤接受胸部CT扫描的136例患者中挑选出来的。不寻常的影像学表现包括孤立的大的骨化性肺肿块、骨化的纵隔和肺门淋巴结、食管纵隔瘘、淋巴管癌病、肺动脉肿瘤栓子、沿叶间裂的孤立的大的胸膜沉积物、多个胸膜沉积物、弥漫性胸膜钙化、气胸、膈肌沉积物、无肺部受累的孤立胸壁沉积物以及肋骨原发性骨肉瘤。我们在一名在世患者中发现淋巴管癌病以及钙化的纵隔淋巴结病导致食管瘘，这在文献中是独特的，我们的其他发现仅有少数病例报告。
