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Intravascular pulmonary metastases from sarcoma: appearance on computed tomography in 3 cases
Patricia T Ting1, Paul W Burrowes, Robin R Gray
1Department of Diagnostic Imaging, Foothills Medical Centre, Calgary, AB.
Summary
Intravascular pulmonary tumor emboli from sarcomas can be asymptomatic and misdiagnosed. Chest CT reveals characteristic tubular, beaded opacities along pulmonary vessels, aiding diagnosis.
Area of Science:
- Radiology
- Oncology
- Pulmonary Medicine
Background:
- Malignant neoplasms commonly metastasize to the lungs, but intravascular pulmonary tumor emboli (IPTE) are rare.
- IPTE can originate from various primary cancers, including sarcomas, presenting diagnostic challenges.
Observation:
- Three cases of IPTE from chondrosarcoma and osteosarcoma are presented.
- Patients exhibited varied symptoms, from asymptomatic to nonspecific respiratory complaints, leading to potential misdiagnosis.
Findings:
- Chest computed tomography (CT) demonstrated a distinctive pattern of multifocal, tubular, branching, and beaded opacities within the pulmonary vasculature.
- CT effectively differentiates IPTE from mucous plugging and parenchymal metastases by visualizing the involved vessels and adjacent bronchi.
Implications:
- Chest CT is crucial for diagnosing IPTE, often revealing characteristic imaging findings.
- Early and accurate diagnosis of IPTE can prevent misdiagnosis as thromboembolic disease and guide appropriate patient management.