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CT images of intrathoracic sarcomatous masses originating from chest wall. A 31-year-old woman (a and b) with Ewing sarcoma, a large mass with irregular shape, lobulated margins, heterogeneous enhancement, intratumoural vessels but no rib erosion. A 34-year-old woman (c and d) with a PNET, presenting an irregular mass, with smooth margins, heterogenous enhancement, rib erosion and intratumoural vessels—these showing a radial pattern in relation to the osseous destruction (arrow in d)
Source publication
To describe the computed tomography (CT) features in a case series of primary intrathoracic extracardiac malignant mesenchymal tumours (sarcomas).
A 5-year retrospective research was conducted, and 18 patients were selected. CT exams were reviewed by two chest radiologists, blinded to tumour pathological type, origin and grade. Lesions were describ...
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Due to the increasing number of COVID-19-infected and vaccinated individuals, radiologists continue to see patients with COVID-19 pneumonitis and recall pneumonitis, which could result in additional workups and false-positive results. Moreover, cancer patients undergoing immunotherapy may show therapy-related pneumonitis during imaging management....
Citations
... [1] Primary mesenchymal tumors of the mediastinum are extremely uncommon and can arise from any structure in the chest. [2] They are usually located in the anterior mediastinum, commonly sporadic and are often asymptomatic until they reach a considerable size wherein symptoms of compression or invasion of the surrounding structures are felt. [3] The role of imaging is huge in the proper assessment of the characteristics, extent of involvement, potential resectability and probable response to treatment of these lesions. ...
... [3] The role of imaging is huge in the proper assessment of the characteristics, extent of involvement, potential resectability and probable response to treatment of these lesions. [2] Radiography is usually the first step and the most helpful in identifying the presence of a mediastinal mass. However, in this case, the discrete location of the posterior mediastinal mass at the level of the diaphragm and its unique growth inferiorly made CT scan a key in the evaluation. ...
... Regardless of location and type, sarcoma should be included as a major differential diagnosis in an intrathoracic mass that is large in size (>70 mm) showing well-defined smooth or lobulated margins, associated pleural effusion, and no significant lymphadenopathy. [2] They also show large areas of low-density suggestive of necrosis and exhibits variable heterogeneous enhancement. [2] Calcifications as well as pleural tags or ground glass opacities are not commonly seen. ...
... Those characteristics are large intrathoracic mass (>70mm); well defined, smooth or lobulated margins; presence of intramural vessels and absence of lymphadenopathy. 5 In the CT images of Mr S, all these characteristics were present, which could be a learning point to refer similar patients early to a thoracic centre once identified. ...
This is a case of a posterior mediastinal mass in an asymptomatic gentleman, which was resected successfully and he has been disease free for more than a year of follow up. The histopathology findings happen to be a rare occurrence.
... Those characteristics are large intrathoracic mass (>70mm); well defined, smooth or lobulated margins; presence of intramural vessels and absence of lymphadenopathy. 5 In the CT images of Mr S, all these characteristics were present, which could be a learning point to refer similar patients early to a thoracic centre once identified. ...
This is a case of a posterior mediastinal mass in an asymptomatic gentleman, which was resected successfully and he has been disease free for more than a year of follow up. The histopathology findings happen to be a rare occurrence.
... the mainstay for thrombus detection, but its prevalence varies considerably among echocardiographic studies because of modest image reproducibility and poorer spatial and soft-tissue resolution than cardiac MRI [18, 19]. Contrast-enhanced cardiac MRI allows differentiation between thrombus and surrounding myocardium because thrombus is avascular and hence is characterized by an absence of contrast uptake. ...
Objective:
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a cause of sudden cardiac death in otherwise healthy young adults. This article outlines the spectrum of MRI findings in ARVC using a combination of static and cine images.
Conclusion:
The detection of right ventricular enlargement, fatty infiltration, fibrosis, and wall motion abnormalities at MRI is useful in the diagnosis of ARVC.
The most common sarcomas in the thorax are metastasis from an extrathoracic primary malignancy. Primary intrathoracic sarcomas are rare albeit aggressive malignancies that are diagnosed on histopathology. Although a few imaging characteristics have been described that are common to sarcomas, it is still a diagnosis of exclusion as other tumors are much more common. Like elsewhere, primary thoracic sarcomas are also classified according to their histologic features. They are a rare group of tumors that can arise from the mediastinal structures, lung, pleura, or chest wall. On imaging, differentiating these from more common malignancies like lung cancer is difficult and often requires multimodality workup and tissue sampling. A few sarcomas are very specific to their locations, such as angiosarcoma in the right atrium, leiomyosarcoma in the pulmonary artery, where imaging has high accuracy for the diagnosis. Despite being nonspecific in a majority of cases, imaging plays a pivotal role in determining the organ of origin, tumor extent, invasion of adjacent structures, and thus help to assess the surgical resectability. Although sarcomas arising from chest wall are the most common primary sarcomas in the chest, they are excluded from this review to focus only on primary intrathoracic sarcomas. The article provides a comprehensive imaging and pathology review of the rare primary intrathoracic sarcomas, including but not limited to angiosarcoma, Kaposi sarcoma, fibrosarcoma, malignant transformation of fibrous tumor of pleura, sarcomatoid mesothelioma, leiomyosarcoma, and malignant small round blue cell tumors.
Key points:
Primary intrathoracic sarcomas are rare but clinically important.
Imaging helps to determine local extent, invasion, metastases and appropriate site/mode of biopsy.
Role of pathology is paramount in diagnosis and guiding treatment based on immunogenetic/molecular typing.
Mediastinum sarcoma is a rare tumor that represents less than 10% of mediastinal tumors and about 1-2% of all malignancies in general. It should be approached in reference centers with multidisciplinary evaluation and multimodal management options, with an infrastructure that allows surgical resection and reconstruction and strict follow-up, taking into account the high local recurrence that is close to 30%. Therefore, we present a series of cases in 20 years of experience with the participation of several departments and adjusting the definition and management with the current literature.
Mediastinum sarcoma is a rare tumor that represents <10% of mediastinal tumors and about 1-2% of all malignancies in general. It must be addressed in referral centers where he evaluated a multidisciplinary and multimodal management options are taken, as well as infrastructure that allows greater surgical resection and reconstruction, given the high local recurrence. We present a series of cases in 20 years of experience with the participation of several departments, fitting the definition and management with the current literature.
Primary tumours of the chest wall and pleura are rare in comparison to tumours of the lung such as bronchial carcinomas. Chest wall tumours are a heterogeneous group that pose an interesting diagnostic challenge for radiologists. They make up less than 5% of thoracic malignancies and vary widely in pathology as they arise from all anatomic structures of the chest wall. Since chemotherapy is rarely effective and local control is the most important prognostic factor, wide local excision might be the solely curative treatment. Therefore, the margins need to be identified by imaging prior to surgery and adjuvant radiation, which might be applied in cases with positive margins. Malignant pleural mesothelioma is an aggressively growing tumour and a rising incidence is expected in the next decades. CT is still the general diagnostic tool for staging and therapy planning of malignant pleural mesothelioma. However, within the last years novel MRI techniques have been developed and introduced into clinical routine to improve tumour delineation and characterization in order to optimize individual therapy planning. Typical findings of those tumours using modern MRI techniques are discussed. Techniques are compared with CT and modern PET techniques, especially concerning characterization, precision of tumour delineation, therapy planning, and monitoring.
