Chest wall tumors

  • indents pleura, form obtuse angles and tapered border
  • osseous origin lesions: grow along or destroy underlying bone
  • lymph or neural origin: paraspinal or intercostal location with bone erosion
  • benign lesions: rib erosion, separation, notch like remodeling without cortical destruction.
  • malignant and inflammatory lesions: bone destruction
  • bone destruction in adults: metastases (breast, lung or kidney), multiple myeloma, lymphoma, sarcoma or primary bone tumor
  • bone destruction in children: Ewing sarcoma, neuroblastoma
  • most common benign chest wall tumor
  • well demarcated
  • -90 to -150 HU
  • few, if any soft tissue components
  • high on T1, intermediate on T2, low on fat suppression
Neurilemmoma (Schwannoma)
  • CT: isodense to spinal cord, enhance post contrast, paraspinal lesions have dumbbell appearance
  • MR: T1 iso or hypointense, T2 heterogeneously hyper intense, intense post Gd enhancement. may show areas of cystic degeneration and hemosiderin
  • solitary, localized or diffuse and plexiform in NF-1
  • similar to schwannomas but with minimal or no contrast enhancement
  • cystic degeneration is rare
  • MR: T2 high signal with target sign (hyper intense rim with central low signal). target sign may be seen in some schwannomas
  • uncommon
  • show phlebolithic calcification, bone remodeling and enhancing mass
  • MR: intermediate T1, high on T2 with artefacts of vessels and hemorrhage
  • fluid filled cyst with or without septation
  • MR: cyst with low protein content
Elastofibroma dorsi
  • benign soft tissue mass adjacent to scapula
  • due to repetitive trauma
  • non encapsulated crescentic masses
  • may be FDG PET avid
Liposarcoma or fibrosarcoma
  • rare
  • well differentiated liposarcoma contains 50-75% adipose tissue, enhancing septa / soft tissue nodules
Fibrohistiocytic neoplasm
  • malignant fibrous histiocytoma, undifferentiated pleomorphic sarcoma
  • most common malignant neoplasm of chest
  • women 55 yrs
  • arise from deep fascia or skeletal muscles
  • 3 subtypes: high grade, sarcoma with giant cells, sarcoma with prominent inflammation
  • osseous structures rarely involved
  • heterogeneous enhancement
  • MR: signal depends on fibrocollagen content which shows low signal
  • most common vascular origin primary neoplasm
  • large painful rapidly enlarging lesion
  • hemorrhage, anemia, coagulopathy
  • associated with lymphedema after mastectomy for breast cancer
  • heterogeneous with areas of necrosis, hemorrhage and vascularity
  • increased FDG PET uptake
Secondary tumors of chest
  • direct spread or invasion from tumors of lung, breast, pleura and mediastinum
  • lymphoma is rare, usually direct invasion from Hodgkin or large B cell from mediastinum. Sign of poor prognosis in lymphoma
  • increased FDG uptake
Bone tumors
  • chondrosarcoma – most common primary malignant tumor adults
  • metastases, multiple myeloma – most common secondary malignant lesions in adults, usually multifocal
  • Ewing sarcoma – most common primary malignant tumor children
  • osteochondroma, chondroma, fibrous dysplasia – most common benign bony tumors
  • eosinophilic granulomas, hemangioma, aneurysmal bone cyst
  • lymphoma, osteosarcoma, round cell tumors
Chondromas, osteochondromas
  • exostoses
  • predominantly anterior
  • characteristic cartilaginous calcification
Fibrous dysplasia
  • lytic with ground glass matrix
  • usually posterior ribs
  • anterior chest wall at costochondral arches
  • lytic lesion with chondroid matrix
Neoplasms of clavicle and sternum
  • commonly myeloma or metastases
  • osteosarcoma, Ewing, postradiation sarcoma, chondrosarcoma, lymphoma
Non neoplastic lesions of clavicle and sternum
  • osteomyelitis, eosinophilic granuloma, Paget disease, fibrous dysplasia, osteitis fibrosa cystica, intersternocostoclavicular hyperostosis