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Intravascular pulmonary metastases from sarcoma: appearance on computed tomography in 3 cases.

INTRODUCTION
Various common malignant neoplasms (ie, liver, kidney, stomach, and breast) have been reported to embolize to the pulmonary arterial system. This uncommon occurrence can also result from metastatic sarcoma. We report 3 cases--2 chondrosarcomas and 1 osteosarcoma-associated with intravascular metastases to the pulmonary vasculature and discuss the clinical presentation and differentiating radiologic features on computed tomography (CT).


DISCUSSION
Intravascular pulmonary tumour emboli may present with nonspecific respiratory symptoms or remain completely asymptomatic, and therefore, many patients are often misdiagnosed with thromboembolic disease or undiagnosed until autopsy. Chest CTs in all our patients demonstrated a striking pattern of multifocal tubular branching beaded opacities along the pulmonary vasculature in a multilobular distribution.


CONCLUSION
Our observations and a review of the literature indicate that chest CT is the most useful diagnostic tool for detecting intravascular pulmonary tumour emboli. CT can distinguish this entity from mucous plugging by demonstrating the normal adjacent bronchus. The tubular nature of these metastases distinguishes them from the more common parenchymal metastases.