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Radiology of Chest Wall Masses: Journal Reading Nurul Hidayati Syarah
Radiology of Chest Wall Masses: Journal Reading Nurul Hidayati Syarah
Journal Reading
02 Ultrasound
Guidancance for biopsy
Choosing an 03 CT
Spatial resolution, mineralization, bony involvement
Imaging
04 MRI
05 PET/CT
Metabolic status of chest wall massess
Scenario 1
Differential Diagnosis Diagnosis:
- Hematoma Chest wall hematoma
- Pectoralis muscle injury and tear -Acute clinical presentation
- Chest wall abscess -Lesion localized within muscle
- Neoplasic proces -Soft tissue enhancement
-Treatment: surgical or conservative
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Chest wall hematoma
Scenario 2
Differential Diagnosis Diagnosis:
- Liposarcoma Liposarcoma
- Atypical lipoma -Large focal areas in the right hemithorax with low
signal on unenchaned T1-weighted MRI, high signal
on T2-weighted MRI, and amorphous enhancement
on contrast-enchaned CT
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Liposarcoma
Scenario 3
Differential Diagnosis Diagnosis:
- Chondrosarcoma Sternoclavicular Hyperostosis
- Osseous metastases -Large amount of proliferation
- Hyperostosis
-Join centered nature of the lesion
- Degenerative processes
-Intact cortical margins
- Osteoarthropaty, trauma
-Lact of involvement of adjacent soft tissue
- SAPHO syndrome
-Intraartiular gas
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Sternoclavicular
Hyperostosis
Scenario 4
Differential Diagnosis Diagnosis:
- Infective cause Elastofibroma Dorsi
- Abscess -Infrascapular location
- Primary sarcoma of chest wall
-Striated appearance
- Neurofibromas
-Absence of invasion
- Plexiform neurofibromas
- Elastofibroma Dorsi
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Elastofibroma Dorsi
Scenario 5
Differential Diagnosis Diagnosis:
- Extrapulmonary Plasmacytoma
- Mesothelioma
-Male, older than 50 years old
- Primary malignancy of the chest wall:
-Arise from bone and expansile
chondrosarcoma
-The most frequent site: vertebral column and ribs
- Multiple myeloma
- Osseous metastatis
- Plasmacytoma
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Plasmacytoma
Scenario 6
Differential Diagnosis Diagnosis:
- Lymph node Schwannoma
- Infective vause -Well defined encapsulated appearance
- Abscess -Omonly cause erosion of adjacent bony structure
- Benign peripheral nerve sheath tumor: -Prominent enchancement on contrast enhanced
shwannoma or neurofibroma images
- Atypical lipoma -Midly FDG avid on PET
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Schwannoma
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Clinical History Description of Images
A 39 year old woman with persistent left anterior chest - Opacity centered on the anterior aspect of the left fifth
wall pain over 3 month period: rib
-No significant medical history - 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
Scenario 7
Differential Diagnosis Diagnosis:
- Agressive process Rib hemangioma
- Metastasis: chondrosarcoma -Imaging play a limited value in this scenario
- Benign: fibrous dysplasia -PET/CT prominent FDG activity in the periphery of
the lesion
-Low grade primary malignant tumor of the chest
wall
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Rib hemangioma
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Clinical History Description of Images
A 31 year old man with 1 month history of persistent left - Soft tissue mass with osseous destruction involving the
upper chest wall pain: left sternal manubrium
-No significant medical history - Extending into extraosseous tissue
-No systemic clinical feature - Amorphous areas of irregular and arclike calcification
within the mass
- Central porsion of the mass is heterogenous
Scenario 8
Differential Diagnosis Diagnosis:
- Osseous manubrium Chondrosarcoma
- Bone metastasis -Stippled and arclike calcification
- Primary tumor -But patients has no history of prior irradioation
- Osteomyelitis
- Osseous neoplasma; Chondrosarcoma,
osteosarcoma
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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
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!