Pulmonary nodules in osteosarcoma patients: differential diagnosis of central venous catheter-related infections in the lungs

Radiol Med. 2006 Mar;111(2):192-201. doi: 10.1007/s11547-006-0020-9.
[Article in English, Italian]


Purpose: The purpose of this study was to evaluate the differential diagnosis of pulmonary nodules by conventional radiography and computed tomography (CT) in osteosarcoma patients with central venous catheter.

Materials and methods: Between March 1997 and December 2001 at our Department of Musculoskeletal Oncology, 231 patients with peripheral osteosarcoma received a central venous catheter to allow infusion therapy and blood sampling. The mean age of these patients was 16 years (range 4-63), and 90 were aged 15 years or younger. All patients underwent radiological investigation for tumour staging and comparison with the following study in accordance with the protocol in place at our Department of Oncology and Division of Diagnostic Imaging.

Results: Of a total of 231 patients, 13 (5.6%) developed an infection of the central venous line, with fever that was very high in some cases. In ten cases (4.3%), radiology showed damage to the alveolar interstitium typical of inflammatory forms, whereas in the remaining three (1.3%) it depicted nodular opacities, which required differentiation between lung metastases and septic emboli. After appropriate antibiotic and replacement of the central venous line, CT demonstrated disappearance of the lung nodules in all three patients, enabling a diagnosis of nodular septic embolism.

Conclusions: Placement of a central venous catheter for infusion therapy, chemotherapy and blood sampling has improved the quality of life of cancer patients. The most common complications of the use of central venous catheters include infection and venous thrombosis whereas pulmonary septic emboli are rare.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Infections / diagnostic imaging*
  • Bone Neoplasms / drug therapy*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / instrumentation*
  • Catheters, Indwelling / adverse effects*
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Lung Diseases / diagnostic imaging*
  • Lung Diseases / etiology
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / secondary
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Osteosarcoma / drug therapy*
  • Osteosarcoma / secondary
  • Pneumonia, Bacterial / diagnostic imaging
  • Pulmonary Alveoli / diagnostic imaging
  • Pulmonary Embolism / diagnostic imaging
  • Sepsis / diagnostic imaging
  • Tomography, X-Ray Computed


  • Anti-Bacterial Agents