Pediatric Radiology

, Volume 46, Issue 1, pp 21–33 | Cite as

Cardiovascular involvement by osteosarcoma: an analysis of 20 patients

  • Sireesha Yedururi
  • Ajaykumar C. Morani
  • Gregory W. Gladish
  • Srilakshmi Vallabhaneni
  • Peter M. Anderson
  • Dennis Hughes
  • Wei-Lien Wang
  • Najat C. Daw
Original Article



Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement.


To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma.

Materials and methods

We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013.


At initial diagnosis, the median age of the patients was 15.1 years (range 4.8–24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0–7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus.


Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus.


Children Computed tomography Heart Inferior vena cava Magnetic resonance imaging Osteosarcoma Positron emission tomography-computed tomography Superior vena cava Tumor thrombus Vascular metastasis 



We are grateful to Nancy E. Fitzgerald, MD, a pediatric radiologist formerly at MD Anderson Cancer Center, for generously contributing the vast majority of the cases reviewed in this study. Most of the imaging findings illustrated in this manuscript are her observations.

This study is supported by the NIH/NCI under award number P30CA016672.

This study was presented in part as a scientific informal poster at the Radiological Society of North America annual meeting in December 2013.

Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  1. 1.Department of Diagnostic RadiologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Internal MedicineMedstar Harbor HospitalBaltimoreUSA
  3. 3.Department of Pediatrics Hematology/Oncology/BMT, Carolinas Healthcare SystemLevine Children’s Hospital/Levine Cancer InstituteCharlotteUSA
  4. 4.Division of PediatricsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  5. 5.Department of PathologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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