Imaging of Chest Wall Masses

Purpose: To highlight the computed tomography (CT) and magnetic resonance imaging (MRI) imaging features in the diagnosis and management of chest wall lesions. Chest wall masses are caused by a spectrum of clinical entities including congenital, developmental, infective, neoplastic, and vascular lesions.

Methods and Materials: We retrospectively reviewed the imaging features and histopathology of 63 patients (40 [63.5%] male, 23 [36.5%] female; aged 12–83 years) referred to our department for imaging with clinical suspicion for a chest wall lesion.

Results: Of 63 patients, 7 patients had a vascular lesion (5 males and 2 females): 4 patients had lymphangioma, 2 patients had slow flow vascular malformation, and 1 patient had a high-flow vascular malformation. One patient had segmental thoracic lipomatosis of nerve with nerve territory overgrowth. Acquired lymphangiectasia of the chest wall was secondary to mastectomy in one patient. Two patients had hidradenitis suppurativa. Poland syndrome was found in two patients. A total of 32 patients (16 male, 16 female) had a benign chest wall tumor: enchondroma, 5 patients; fibrous dysplasia, 7 patients; neurilemoma, 3 patients; osteochondroma, 4 patients; desmoid, 2 patients; lipoma, 8 patients; fibrolipoma, 1 patient; aneurysmal bone cyst, 2 patients; and intraosseous hemangioma, 1 patient.

Nine patients (7 males, 2 females) had a malignant chest wall tumor: dermatofibrosarcoma protuberans, 1 patient; chondrosarcoma, 3 patients; extraskeletal osteosarcoma,1 patient, Ewing’s sarcoma, 2 patients; squamous cell carcinoma metastasis in 1 patient; and adenocarcinoma metastasis in 1 patient. Distinction between benign and malignant chest wall tumors was made using radiographic criteria in most of the patients, and diagnosis was always confirmed histologically.

Nine patients had infective etiology (7 males and 2 females): 4 patients had tuberculous infection of the chest wall, 4 patients had pyogenic infection, and 1 patient had actinomycosis.

Conclusion: Imaging evaluation with CT and MRI plays an vital role in the accurate diagnosis of chest wall lesions by classifying the etiology. Imaging can also facilitate planning of a proper biopsy for tissue sampling. Imaging also enables accurate staging and is a key component of treatment planning for chest wall masses.

Fig. 1 Extensive multicompartmental venous malformation.

Fig. 2 Extraskeletal osteosarcoma (pleomorphic sarcoma).

Fig. 3 Dermatofibrosarcoma protuberans.

Fig. 4 Tuberculous empyema necessitates.

Publication History

Article published online:
17 December 2020