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


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.
Longhi
A
A
Sezione di Chemioterapia, Dipartimento di Oncologia Muscoloscheletrica, Istituti Ortopedici Rizzoli, Bologna, Italy. alessandra.longhi@ior.it
Rimondi
E
E
Loro
L
L
Tetta
C
C
Rossi
G
G
DeBenedittis
M
M
Bacci
G
G