Atypical pulmonary metastases in children: pictorial review of imaging patterns
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PICTORIAL ESSAY
Atypical pulmonary metastases in children: pictorial review of imaging patterns Marie-Helene Gagnon 1
&
Andrew B. Wallace 1 & Sireesha Yedururi 2 & Geetika Khanna 1
Received: 8 May 2020 / Revised: 2 August 2020 / Accepted: 18 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Pulmonary metastases typically present as well-circumscribed solid nodules, often with a basilar and peripheral distribution due to hematogenous spread. When an atypical pattern of metastasis occurs, a lack of recognition may result in understaging or a delay in diagnosis. The purpose of this article is to review the imaging findings of atypical pulmonary metastatic disease in children. Atypical pulmonary metastatic patterns that can be seen in children include cavitary lesions, calcified pulmonary nodules, nodules with peritumoral halos, tree-in-bud or strial pattern secondary to tumor in peripheral pulmonary arterial branches, lymphangitic carcinomatosis, and miliary disease. An awareness of the spectrum of imaging findings of atypical pulmonary metastases along with an understanding of histopathological underpinnings will allow the radiologist to make an accurate diagnosis. Keywords Atypical . Children . Computed tomography . Lungs . Metastases . Pulmonary . Radiography
Background Pulmonary metastases account for 95% of malignant lung lesions in children [1]. Additionally, the lungs are the most common site of distant blood-borne metastasis. The most common pediatric solid tumors resulting in pulmonary metastasis are Wilms tumor and osteosarcoma [2]. Approximately 14% of pediatric osteosarcoma cases have lung metastasis at initial presentation, with the highest risk being in osteoblastic osteosarcoma [3]. Other pediatric malignancies that have a predilection for pulmonary metastasis include embryonal tumors and sarcomas (both osteosarcoma and soft-tissue sarcomas). Typical imaging findings of pulmonary metastases are single or multiple nodules, which are well circumscribed,
CME activity This article has been selected as the CME activity for the current month. Please visit the SPR website at www.pedrad.org on the Education page and follow the instructions to complete this CME activity. * Marie-Helene Gagnon [email protected] 1
Pediatric Imaging, Mallinckrodt Institute of Radiology, Washington University in St. Louis, 510 S. Kingshighway, Campus Box 8131, St. Louis, MO 63110, USA
2
Abdominal Imaging Department, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
solid and round [4]. They tend to be peripheral and have a lower lobe predilection due to hematogenous spread. However, not all pulmonary metastases will show these typical characteristics and it is important to recognize atypical patterns of pulmonary metastases in children in order to prevent a delay in diagnosis and treatment. Imaging characteristics of atypical pulmonary metastases include cavitary nodules, calcified nodules, spontaneous pneumothorax, pleural metastases, peritumoral halo, tumor embolism, atelec
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