Daily Radiology Case

Explanation

This case represents pulmonary metastases from osteosarcoma, with both a partially calcified metastasis and a nearby non-calcified metastatic nodule in the left upper lobe. The calcified appearance is a classic clue, as osteosarcoma metastases can ossify or calcify within the lung. Pathology confirmed metastatic osteosarcoma in both nodules, with lymphovascular invasion and pleural surface involvement, while the resection margin remained clear.

Source: Rottenberg A, Calcified lung metastasis - osteosarcoma. Case study, Radiopaedia.org (Accessed on 01 Apr 2026) https://doi.org/10.53347/rID-231483

Hints

• 30-year-old man with history of treated malignancy undergoing follow-up surveillance chest radiograph.
• The lesion is located in the medial left upper lobe, closely abutting the mediastinal pleura.
• The dominant lesion is a partially calcified subpleural mass, an important imaging feature that narrows the differential for a pulmonary mass in a young adult.
• There is also an adjacent non-calcified soft tissue nodule, showing that the pulmonary disease is not limited to a single calcified focus.
• Despite its close relationship to the left subclavian artery, there is no vascular encasement or invasion, favoring a pleural/parenchymal metastatic deposit rather than an aggressive primary mediastinal vascular process.
• Pathology from wedge resection shows two separate nodules, both involving the pleural/subpleural region, with lymphovascular invasion and breach of the pleural surface, supporting hematogenous spread.
• When a young male with a history of treated malignancy develops calcified and non-calcified pulmonary nodules, the leading consideration is metastatic spread from a bone-forming primary tumor.