Background The clinical significance of subcentimeter nodules identified on staging chest Computed Tomography (CT) for sarcoma remains unknown. Our goal was to evaluate the effect of initial pulmonary nodule size and number on survival rates in young, newly diagnosed sarcoma patients. Methods Medical records were reviewed for all patients ≤50 years of age with primary, high-grade bone or soft tissue sarcoma at our institution over a 10-year period. This population was divided into patients with no nodules (Group 1); 1 nodule <5 mm (Group 2); >1 nodule <5 mm (Group 3); and ≥1 nodule ≥5 mm (Group 4). Kaplan-Meier analyses with log rank tests were performed to compare overall and disease free survival between these 4 groups, as well as between patients with unilateral and bilateral nodules. Results There were 74 patients in Group 1 (59.2%), 26 in Group 2 (21%), 11 in Group 3 (9%), and 13 in Group 4 (10%). Mean follow up was 74 (range 6-191) months. Survival was only slightly worse with larger nodules but significantly worse with multiple nodules. In addition, patients with bilateral nodules had a significantly worse prognosis than those with multiple unilateral nodules. Conclusions This data suggests that in young patients with high grade sarcoma, the number and distribution of subcentimeter pulmonary nodules are an important prognostic factor, while nodule size may be less relevant.