Journal Reading
Ultrasound
02 Guidancance for biopsy
Choosing 03 CT
Spatial resolution, mineralization, bony involvement
an Imaging MRI
04
Technique Superior soft tissue resolution
PET/CT
05 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
14
Clinical History Description of Images
A 39 year old woman with persistent left anterior chest wall - Opacity centered on the anterior aspect of the left fifth
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 guidane
19
Thank you!