Radiology of Chest Wall Masses

Journal Reading
Nurul Hidayati Syarah

Preceptor : dr. Dessy Wimelda, Sp.Rad

American Roentgen Ray Society

Charles P. Mullan; Rachna Madan; Beatrice Trotman-Dickenson;
Xiaohua Qian; Francine L. Jacobson; Andetta Hunsaker
 01 Radiography

Choosing an 02 Ultrasound

Imaging 03 CT

Technique 04 MRI

PET/CT
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Clinical History
A 76 year old man with remote history of
aortic and mitral valve replacement presented
with acute chest wall pain:
- ECG within normal
- Pain, tenderness, and swelling in the left
anterolateral chest wall
- No symptoms or history of fever
- WBC normal
Description of Images
- Chest radiograph: cardiomegaly, left atrial
enlargement, prior sternotomy
- Large well defined lesion in the left
anterolateral chest wall containing high
signal material, with layering of intermediate
to high signal material in depdendent
portion
- STIR: lesion containing fluid

Scenario 1
Diagnosis
Chest wall hematoma

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Chest wall hematoma

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Clinical History
A 53 years old man presented with a history
of progressive dyspnea and alered sensation
in the right upper limb:
- No significant medical history
- Chest radiograph showed diffuse
abnormality in the right hemithorax
- CT obtained
Description of Images
- Large mass lesion in right hemithorax;
compressing lung
- Predominantly Fat attenuation
- Septations within fat component
- Invasion of hepatic dome

Scenario 2
Diagnosis
Liposarcoma

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Liposarcoma

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Clinical History Description of Images
A 64 old woman with history of left breast
carcinoma: - An abnormal osseous excresscence
- Osseous abnormality in the left anterior chest - Periosteal reation
wall - Margins of lesions are well defined, no
- Sustaining minor injuries following a motor inflammatory changes
vehicle accident 2 years previously - Bone proliferation
- Asymptomatic - Intraarticular gas

Scenario 3
Differential Diagnosis Diagnosis
- Osseous metastases
Sternoclavicular Hyperostosis
- Hyperostosis - Large amount of proliferation
- Degenerative processes - Join centered nature of the lesion
- Osteoarthropaty - Intact cortical margins
- Lact of involvement of adjacent soft tissue

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Sternoclavicular
Hyperostosis

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Clinical History Description of Images
- Soft tissue mass with intermediate signal
A 60 year old man with increasing discomfort in
on proton density imaging
the right posterior chestwall over 3 month period:
- Lesion more heterogenous than
- No significant medical history
neighboring skeletal muscle
- Ill defined palpable swelling adjacent to the
- Alternating high and intermediate signal
inferior pole of the right scapula
areas

Scenario 4
Differential Diagnosis Diagnosis:
- Abscess Elastofibroma Dorsi
- Primary sarcoma of chest wall - Infrascapular location
- Neurofibromas - Absence of invasion

- Plexiform neurofibromas

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Elastofibroma Dorsi

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Clinical History
A 50 year old man with right posterior rib pain:
- No significant medical history
- No history of trauma
Description of Images
- Large soft tissue lesion in posterior right
chest wall; causing desctruction of ribs
- Invasion of right lamina and right pedicle of
T5 vertebra, and abutting right side of spinal
canal
- Lesion is homogenous
- Obtuse angle with chest wall

Scenario 5
Differential Diagnosis Diagnosis:
Plasmacytoma
- Extrapulmonary
- Male, older than 50 years old
- Mesothelioma
- Arise from bone and expansile
- Primary malignancy of the chest wall:
- The most frequent site: vertebral column and
chondrosarcoma
ribs

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Plasmacytoma

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Clinical History Description of Images
A 48 year old man with no symptoms - Homogenous well circumscribed right
related to the mass: subclavicular soft tissue mass, slightly
- Incidental finding of an upper right hypoattenuation
chest wall mass - Lesion has dumbbell shape and extends into
first intercostal space
- Mildly avid on PET/CT examination

Scenario 6
Diagnosis:

Schwannoma
- Well defined encapsulated appearance
- Omonly cause erosion of adjacent bony
structure
- Prominent enchancement on contrast
enhanced images
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Schwannoma

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Clinical History
A 39 year old woman with persistent left
anterior chest wall pain over 3 month
period:
- No significant medical history
Scenario 7
Differential Diagnosis
- Agressive process
- Metastasis: chondrosarcoma
- Benign: fibrous dysplasia
Description of Images
- Opacity centered on the anterior aspect of the
left fifth rib
- Expansile, with bony spicules radiating from
central portion and loss of normal cortical rib
margins
- Central fibrous stroma containing areas of
calcification and highly vascular peripheral
component
Diagnosis:
Rib hemangioma
- Imaging play a limited value in this scenario
- Low grade primary malignant tumor of the
chest wall
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Rib hemangioma
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Clinical History
A 31 year old man with 1 month history of
persistent left upper chest wall pain:
- No significant medical history
- No systemic clinical feature
Scenario 8
Diagnosis
Chondrosarcoma
- Stippled and arclike calcification
- But patients has no history of prior irradioation
Description of Images
- Soft tissue mass with osseous destruction
involving the left sternal manubrium
- Extending into extraosseous tissue
- Amorphous areas of irregular and arclike
calcification within the mass
- Central porsion of the mass is heterogenous
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Chondrosarcoma

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 A systematic problem-based approach is required to
define the differential diagnosis and to determine the
most appropriate investigation to characterize the
lesions
Inf it is not possible to secure a diagnosis by imaging

Conclusion alone, biopsy will be necessary under CT or

ultrasound guidane
PET/CT will targeting biopsy toward metabolically
active area
The correlation of clinical, radiologic, and pathologic
data is required for optimal treatment planning of
chest wall masses

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Thank you!