CHEST RADIOLOGY. pattern and differential diagnosis. Text book of chest radiology. differential diagnosis. chest wall and pleural lesions, CT and CXR

1. Maw Maw Oo

3. Chest wall lesions - may arise from both extrathoracic and intrathoracic
locations as well as normal and abnormal structures.
Cutaneous lesions should not have the tapered borders that are
seen in this .
The tapered border indicates displacement of the pleura inward by the
mass and has been described as an extrapleural sign.
The tapered border of this mass indicates an intrathoracic
extrapulmonary location.
The expansile lytic destruction of the adjacent rib confirms the
chest wall origin of the mass. The patient has a known diagnosis of
multiple myeloma

4. Extra-thoracic chest wall
opacities are seen as soft-tissue
opacities with an incomplete,
sharp border.
This large, left mass has a sharp lateral
border because it is outlined by air, but has
the incomplete medial border sign. The
mass is obviously outside of the rib cage
and easily identified as a chest wall mass.
Physical examination revealed this to be a
soft, pliable mass in this neonate, making
lymphangioma the most likely diagnosis

5. This large, right-upper, lateral thoracic mass has tapered
superior and inferior borders with the additional finding
of an opacity that follows the posterior aspect of the
right third and fourth ribs. The widening of the
interspace between the second and third ribs is the
result of the mass. There is also lateral destruction of the
third rib. The opacity
is greater than that of the surrounding ribs, indicating a
blastic bone reaction that is the result of calcified tumor
matrix. This is a rare case of osteosarcoma arising from
the chest
wall. Prostate and breast cancers are common primary
tumors and are common causes of blastic bone
metastases that may involve the thoracic skeleton.

12. This patient with neurofibromatosis has bilateral,
elongated, tapered, smooth, peripheral masses,
and multiple ribs are inferiorly eroded
Computed tomography confirms the peripheral
masses with extension of the left lateral mass
through the chest wall. The posterior extension of
the mass was not suspected from the radiograph.

13. This elongated tapered mass in the right
costophrenic angle has invaded and destroyed a
portion of the adjacent rib, which confirms chest
wall involvement. These observations narrow the
differential to metastasis vs. multiple myeloma or
plasmacytoma. The patient’s history of renal cell
carcinoma confirms the diagnosis of metastasis

14. Schwannoma has not destroyed the rib
but has eroded its inferior cortex. Note
sclerotic border, which virtually
ensures the benign nature of the lesion

19. Advanced Hodgkin lymphoma has caused this large soft-tissue
mass.
The incomplete borders indicate an extrapulmonary location,
but the chest radiograph reveals no evidence of the chest
wall extension.
Computed tomography scan shows the peripheral soft-tissue
opacity to have tapered borders and to extend through the
chest wall. Multiple pulmonary nodules were also confirmed.

21. A-Multiple osteochondromas produce calcified soft-tissue masses. These masses often cause considerable
chest wall deformity with spreading of ribs. They may also cause intrathoracic and extrathoracic soft-
tissue masses. This patient with hereditary multiple exostoses has two large masses. The smaller superior
mass is an osteochondroma. The large inferior mass obliterates the costophrenic angle and extends into
the extrathoracic soft tissues. Because of recent growth, a biopsy was performed confirming the diagnosis
of chondrosarcoma.
B, Computed tomography (CT) of the smaller superior osteochondroma shows a typical pattern of
calcification.
C, CT of the larger inferior chondrosarcoma shows a large soft-tissue mass with irregular bands of calcified
matrix.

22. This mass has protruded into the thorax, elevating the pleura,
as evidenced by the tapered borders. The calcified matrix has a
speckled, reticulated appearance that is typical of a cartilage
matrix.
In addition, there is a well-defined, calcified cortex. These
features are diagnostic of an osteochondroma.

24. A, Compare this case with the case seen in Fig. 2.2, A. This elongated opacity follows the
left anterior third rib, indicating a chest wall origin. The opacity is lobulated and blastic. Blastic rib
lesions are a common appearance of prostate metastases, but the lobulated, expansile chest wall
mass is unusual.
B, The blastic lesion in the lower thoracic vertebra confirms the presence of multiple blastic
bone lesions. This is a common appearance of metastatic prostate cancer.

26. A, This coronal computed tomography (CT) reveals multiple left upper lobe cavities that
are highly suggestive of active tuberculosis (discussed in Chapter 24). B, The axial CT images
reveal extensive anterior soft-tissue swelling with a central low attenuation fluid-filled structure.
This is the result of extension of the infection through the chest wall causing tuberculous
cellulitis and abscess

28. A, This right-lower thoracic opacity has no detectable borders on the PA radiograph.
B,The lateral review reveals a well-circumscribed, posterior, elongated, mass-like opacity.
C, Computed tomography reveals mixed attenuation of the posterior opacity with an associated rib fracture. This
confirms a chest wall hematoma

30. Superior sulcus (Pancoast) tumors are primary lung cancers
that often invade the pleura and chest wall. Notice the poorly
defined inferior border of the mass that distinguishes it from a
chest wall or pleural mass. The tumor has destroyed multiple
ribs and vertebrae.