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Case 95

Young man with chest and leg pains

Pulmonary metastasis from osteosarcoma, pneumothorax

Dr Sajid Sayyad

This twenty year old male patient presented with sudden onset of right sided pleuritic chest pain. he also gave a history of worsening pain in the leg over the last 6 months.

What are the findings on the two radiographs and how are they correlated?

Findings

Chest X-ray - Right pneumothorax

Tibia & Fibula X-ray - Lytic lesion with areas of osteod matrix in midportion of right tibia with a motheaten appearance of adjacent trabeculae, a sunburst type of periostal reaction, soft tissue involvement and evidence of a well defined sclerotic lesion in the distal end.

Diagnosis

Spontaneous pnuemothorax due to pulmonary metastasis from osteosarcoma

Discussion

Regarding Osteogenic Sarcoma:

1. Occurs in the age group 10-25 years mainly in the distal femur, proximal tibia, proximal humerus and pelvis
2. Appearances
   • Metaphyseal
   • May be predominantly lytic, sclerotic or mixed
   • Wide zone of transition with normal bone
   • Cortical destruction with soft-tissue extension
   • +/- internal calcification of bone
   • Periostal reaction - 'sunray' spiculation, lamellated and/or Codman's triangle
3. Spontaneous pneumothorax
   • An unusual but recognised complication of lung metastasis. Metastasis from sarcoma, mainly osteogenic, is the common cause. A contributory role of chemotherapy to cause pneumothorax has been suggested

References

Grainger and Allison's Diagnostic Radiology. Vol 1, p 254

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