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- 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
Lipoma
- 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
Neurofibroma
- 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
Hemangioma
- uncommon
- show phlebolithic calcification, bone remodeling and enhancing mass
- MR: intermediate T1, high on T2 with artefacts of vessels and hemorrhage
Lymphangioma
- 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
Angiosarcoma
- 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
Chondrosarcoma
- 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