Ann Thorac Surg 2004;77:341
© 2004 The Society of Thoracic Surgeons
Images in cardiothoracic surgery
Pulmonary tumor embolism secondary to osteosarcoma
Poo-Sing Wong, FRCS (CTh)a*,
Winn M. M. Aye, AFRCSIa,
Chuen-Neng Lee, FRACSa
a Department of Cardiac Thoracic and Vascular Surgery, National University Hospital, Singapore, Singapore
* Address reprint requests to Dr Wong, Department of Cardiac Thoracic and Vascular Surgery, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074
e-mail: surwps{at}nus.edu.sg
We present a case of pulmonary tumor embolism secondary to osteosarcoma. A 14-year-old boy presented with a painful swelling in his right knee and worsening dyspnea. Enhanced computed tomography of the chest showed filling defects in both the right and left pulmonary arteries (Fig 1).
Roentgenogram of the right knee showed appearances consistent with osteogenic sarcoma. A differential diagnosis of tumor embolism was made and the patient underwent emergency pulmonary embolectomy under cardiopulmonary bypass.
When the pulmonary arteries were opened, a whitish, soft tumor embolus mushroomed out. The growth had a papillary surface and most of the tumor was extracted piecemeal from both the right and left pulmonary arteries. A whole piece of tumor embolus was extracted from the middle and lower lobe branches of the pulmonary artery, which had extended into the segmental branches (Fig 2),
through an incision in the pulmonary artery behind the superior vena cava and ascending aorta. Histology examination showed histologic features consistent with osteosarcoma.
The patient made an unremarkable recovery and was discharged from the hospital on the 20th postoperative day. He underwent chemotherapy before a right above-knee amputation was performed. Despite different regimes of chemotherapy, multiple bilateral pulmonary metastases developed.
Although metastatic spread of tumor to the lungs is common, massive pulmonary tumor emboli are unusual. Most tumor emboli originate from epithelial-derived tumors. Only a few cases of pulmonary embolism from sarcoma have been reported.
