Pleural Metastases from Primary Femoral Sarcoma in a Child: A Rare Case Report

Abstract

Background: Primary malignant bone sarcomas are rare but aggressive pediatric tumors with a strong tendency for pulmonary metastasis, while pleural spread is exceptionally uncommon and diagnostically challenging. Aims: To report a rare case of pleural metastatic dissemination from a primary femoral sarcoma in a pediatric patient and to describe its computed tomography features. Study Design: Case report. Presentation of Case: An 8-year-old girl previously treated for malignant sarcoma of the distal femur presented seven months later with acute respiratory distress. Chest computed tomography revealed extensive heterogeneous pleural masses with internal calcifications, peripheral enhancement, and significant compressive effect on the right lung, causing near-complete pulmonary collapse and mediastinal shift. Associated pulmonary nodules were also identified. The imaging findings were consistent with extensive pleural metastatic involvement. Discussion: Pleural metastases from primary bone sarcomas are extremely uncommon in children. Their radiological appearance may mimic primary pleural malignancies or other thoracic neoplasms, making diagnosis challenging. Recognition of calcified pleural metastatic lesions in patients with known primary bone tumors is essential for accurate diagnosis and appropriate management. Conclusion: Pleural metastatic dissemination should be considered in pediatric patients with primary bone sarcoma presenting with new thoracic symptoms, particularly when imaging demonstrates calcified pleural masses.