Imaging of Chest Wall Disorders1
Mi-Young Jeung, MD,
Afshin Gangi, MD, PhD,
Bernard Gasser, MD,
Cornelia Vasilescu, MD,
Gilbert Massard, MD,
Jean-Michel Wihlm, MD and
Catherine Roy, MD
1 From the Departments of Radiology B (M.Y.J., A.G., C.V., C.R.), Pathology (B.G.), and Thoracic Surgery (G.M., J.M.W.), University Hospital of Strasbourg, 1 place de l'Hôpital, 67091 Strasbourg, France. Recipient of a Certificate of Merit award for a scientific exhibit at the 1997 RSNA scientific assembly. Received April 21, 1998; revision requested May 13 and received July 10; accepted July 10. Address reprint requests to M.Y.J.
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Figure 1a. Funnel chest in a 21-year-old man admitted for surgical correction. (a) Posteroanterior chest radiograph shows leftward displacement of the heart. (b) Lateral chest radiograph demonstrates severe depression of the sternum. (c) CT scan clearly demonstrates compression of the heart by the depressed sternum and allows quantification of the severity of sternal deformity.
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Figure 1b. Funnel chest in a 21-year-old man admitted for surgical correction. (a) Posteroanterior chest radiograph shows leftward displacement of the heart. (b) Lateral chest radiograph demonstrates severe depression of the sternum. (c) CT scan clearly demonstrates compression of the heart by the depressed sternum and allows quantification of the severity of sternal deformity.
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Figure 1c. Funnel chest in a 21-year-old man admitted for surgical correction. (a) Posteroanterior chest radiograph shows leftward displacement of the heart. (b) Lateral chest radiograph demonstrates severe depression of the sternum. (c) CT scan clearly demonstrates compression of the heart by the depressed sternum and allows quantification of the severity of sternal deformity.
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Figure 2a. Pigeon breast in a 25-year-old woman. (a) Lateral chest radiograph shows a bulging sternum. (b) CT scan reveals the degree of sternal protrusion and asymmetry of the chest wall.
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Figure 2b. Pigeon breast in a 25-year-old woman. (a) Lateral chest radiograph shows a bulging sternum. (b) CT scan reveals the degree of sternal protrusion and asymmetry of the chest wall.
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Figure 3a. Cervical rib syndrome in a 17-year-old girl with pain and weakness of the right arm in certain positions. (a) Coned-down radiograph demonstrates a left cervical rib and pseudoarthrosis between a right cervical rib and the first rib. (b) Contrast material–enhanced CT scan shows compression of the right subclavian artery by the clavicle and cervical rib (arrow).
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Figure 3b. Cervical rib syndrome in a 17-year-old girl with pain and weakness of the right arm in certain positions. (a) Coned-down radiograph demonstrates a left cervical rib and pseudoarthrosis between a right cervical rib and the first rib. (b) Contrast material–enhanced CT scan shows compression of the right subclavian artery by the clavicle and cervical rib (arrow).
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Figure 4. Cleidocranial dysostosis in a 46-year-old woman. Chest radiograph shows defective, hypoplastic clavicles (arrows).
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Figure 5a. Poland syndrome in a 17-year-old boy with syndactyly of the left hand. (a) Chest radiograph shows diffuse hyperlucency on the left side. (b) CT scan obtained at the level of the sternoclavicular junction demonstrates aplasia of the greater pectoral muscle.
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Figure 5b. Poland syndrome in a 17-year-old boy with syndactyly of the left hand. (a) Chest radiograph shows diffuse hyperlucency on the left side. (b) CT scan obtained at the level of the sternoclavicular junction demonstrates aplasia of the greater pectoral muscle.
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Figure 6. Figures 6, 7. (6) Sternal osteomyelitis caused by ß-hemolytic Streptococcus organisms in a 46-year-old diabetic woman with fever and presternal swelling. CT scan shows pneumonia in the right upper lobe, bone destruction of the sternum, and a peristernal fluid collection with air bubbles. (7) Costal chondritis caused by Staphylococcus aureus in a 54-year-old man who presented with cutaneous fistula and swelling of a thoracic wall scar 1 month after undergoing resection of a mouth carcinoma. Contrast-enhanced CT scan reveals destruction of the fourth cartilage associated with soft-tissue infiltration.
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Figure 7. Figures 6, 7. (6) Sternal osteomyelitis caused by ß-hemolytic Streptococcus organisms in a 46-year-old diabetic woman with fever and presternal swelling. CT scan shows pneumonia in the right upper lobe, bone destruction of the sternum, and a peristernal fluid collection with air bubbles. (7) Costal chondritis caused by Staphylococcus aureus in a 54-year-old man who presented with cutaneous fistula and swelling of a thoracic wall scar 1 month after undergoing resection of a mouth carcinoma. Contrast-enhanced CT scan reveals destruction of the fourth cartilage associated with soft-tissue infiltration.
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Figure 8. Poststernotomy infection from Staphylococcus aureus in a 65-year-old man who developed a cutaneous fistula of a sternotomy scar 3 weeks after undergoing coronary bypass surgery. Contrast-enhanced CT scan shows a sternal dehiscence and diffuse mediastinal fat infiltration (arrows).
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Figure 9a. Surgically created fistula from open-window thoracostomy performed in a 60-year-old man who had developed a chronically infected empyema following double lobectomy of the right middle and lower lobes for bronchogenic carcinoma. Drainage procedures and antibiotic therapy proved ineffective. (a) Chest radiograph shows a surgically created fistula between the pleural cavity and the skin (arrows). (b) CT scan reveals an opening in the thoracic wall. The interposed muscle flap contains fat (arrows). The right side of the pleural cavity is filled with fluid.
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Figure 9b. Surgically created fistula from open-window thoracostomy performed in a 60-year-old man who had developed a chronically infected empyema following double lobectomy of the right middle and lower lobes for bronchogenic carcinoma. Drainage procedures and antibiotic therapy proved ineffective. (a) Chest radiograph shows a surgically created fistula between the pleural cavity and the skin (arrows). (b) CT scan reveals an opening in the thoracic wall. The interposed muscle flap contains fat (arrows). The right side of the pleural cavity is filled with fluid.
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Figure 10. Tuberculous abscess in a 27-year-old woman with acquired immunodeficiency syndrome who complained of right lower chest pain and swelling. The patient had been treated for pulmonary tuberculosis 2 month earlier. Contrast-enhanced CT scan demonstrates a well-defined, multiloculated abscess in the right lower thoracic wall (arrows).
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Figure 11a. Infected extraperiosteal plombage space in a 56-year-old man who presented with fever and chest pain. The patient had undergone extraperiosteal plombage with Lucite balls 15 years earlier. (a) Posteroanterior chest radiograph shows the dispersed Lucite balls in the right apex. (b, c) CT scan (b) and sagittal T1-weighted MR image (c) show an abundant collection of fluid in the extraperiosteal plombage space and migration of some Lucite balls to the subpleural and paravertebral subcutaneous regions.
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Figure 11b. Infected extraperiosteal plombage space in a 56-year-old man who presented with fever and chest pain. The patient had undergone extraperiosteal plombage with Lucite balls 15 years earlier. (a) Posteroanterior chest radiograph shows the dispersed Lucite balls in the right apex. (b, c) CT scan (b) and sagittal T1-weighted MR image (c) show an abundant collection of fluid in the extraperiosteal plombage space and migration of some Lucite balls to the subpleural and paravertebral subcutaneous regions.
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Figure 11c. Infected extraperiosteal plombage space in a 56-year-old man who presented with fever and chest pain. The patient had undergone extraperiosteal plombage with Lucite balls 15 years earlier. (a) Posteroanterior chest radiograph shows the dispersed Lucite balls in the right apex. (b, c) CT scan (b) and sagittal T1-weighted MR image (c) show an abundant collection of fluid in the extraperiosteal plombage space and migration of some Lucite balls to the subpleural and paravertebral subcutaneous regions.
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Figure 12. Tuberculous pleurocutaneous fistula in a 61-year-old woman who presented with fever and a cutaneous fistula in the left paravertebral area. The patient had undergone collapse therapy for tuberculosis 44 years earlier and thoracoplasty for infection of a plombage space 5 years afterward. CT scan shows an abscess collection in the chest wall (arrowhead) and pleural effusion. Results of biopsy of the cutaneous fistula confirmed the recurrence of tuberculosis.
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Figure 13a. Actinomycosis with empyema necessitatis in a 61-year-old woman who presented with fever and a fluctuant mass of the left chest wall. The patient had been treated for multiple pelvic fractures sustained in a motor vehicle accident 1 month earlier. (a) Collimated radiograph shows irregular destruction and fractures of the sixth and seventh left ribs (arrows). (b) Contrast-enhanced CT scan reveals a well-defined, fluid-filled mass with marked rim enhancement (arrowheads) in the thoracic wall and airspace consolidation in the adjacent lung parenchyma. (c) Low-power photomicrograph (original magnification, x50; hematoxylin-eosin stain) of resected tissue shows a typical sulfur granule surrounded by numerous polynuclear leukocytes.
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Figure 13b. Actinomycosis with empyema necessitatis in a 61-year-old woman who presented with fever and a fluctuant mass of the left chest wall. The patient had been treated for multiple pelvic fractures sustained in a motor vehicle accident 1 month earlier. (a) Collimated radiograph shows irregular destruction and fractures of the sixth and seventh left ribs (arrows). (b) Contrast-enhanced CT scan reveals a well-defined, fluid-filled mass with marked rim enhancement (arrowheads) in the thoracic wall and airspace consolidation in the adjacent lung parenchyma. (c) Low-power photomicrograph (original magnification, x50; hematoxylin-eosin stain) of resected tissue shows a typical sulfur granule surrounded by numerous polynuclear leukocytes.
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Figure 13c. Actinomycosis with empyema necessitatis in a 61-year-old woman who presented with fever and a fluctuant mass of the left chest wall. The patient had been treated for multiple pelvic fractures sustained in a motor vehicle accident 1 month earlier. (a) Collimated radiograph shows irregular destruction and fractures of the sixth and seventh left ribs (arrows). (b) Contrast-enhanced CT scan reveals a well-defined, fluid-filled mass with marked rim enhancement (arrowheads) in the thoracic wall and airspace consolidation in the adjacent lung parenchyma. (c) Low-power photomicrograph (original magnification, x50; hematoxylin-eosin stain) of resected tissue shows a typical sulfur granule surrounded by numerous polynuclear leukocytes.
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Figure 14a. Invasive aspergillosis mimicking a superior sulcus tumor in a 37-year-old man with a 2-month history of right arm and shoulder pain. (a) Contrast-enhanced CT scan demonstrates an irregular cavitary subpleural-based lesion infiltrating extrapleural fatty tissue (arrowheads). (b) Sagittal T1-weighted MR image shows a poorly marginated lesion extending superiorly into the chest wall (arrows). (c) Low-power photomicrograph (original magnification, x12; hematoxylin-eosin stain) of resected tissue shows multiple conglomerations of interwoven fungal hyphae (arrows) surrounded by necrotic lung parenchyma.
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Figure 14b. Invasive aspergillosis mimicking a superior sulcus tumor in a 37-year-old man with a 2-month history of right arm and shoulder pain. (a) Contrast-enhanced CT scan demonstrates an irregular cavitary subpleural-based lesion infiltrating extrapleural fatty tissue (arrowheads). (b) Sagittal T1-weighted MR image shows a poorly marginated lesion extending superiorly into the chest wall (arrows). (c) Low-power photomicrograph (original magnification, x12; hematoxylin-eosin stain) of resected tissue shows multiple conglomerations of interwoven fungal hyphae (arrows) surrounded by necrotic lung parenchyma.
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Figure 14c. Invasive aspergillosis mimicking a superior sulcus tumor in a 37-year-old man with a 2-month history of right arm and shoulder pain. (a) Contrast-enhanced CT scan demonstrates an irregular cavitary subpleural-based lesion infiltrating extrapleural fatty tissue (arrowheads). (b) Sagittal T1-weighted MR image shows a poorly marginated lesion extending superiorly into the chest wall (arrows). (c) Low-power photomicrograph (original magnification, x12; hematoxylin-eosin stain) of resected tissue shows multiple conglomerations of interwoven fungal hyphae (arrows) surrounded by necrotic lung parenchyma.
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Figure 15. Transthoracic lipoma in a 75-year-old man. CT scan shows a low-attenuation mass (arrows) surrounding the transverse muscle of the thorax at the anterior chest wall and invaginating the lung.
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Figure 16a. Intercostal schwannoma in a 72-year-old woman with a known area of increased opaci-ty in the left upper lobe. (a) Contrast-enhanced CT scan shows a well-defined, heterogeneous solid mass attached to the thoracic wall. (b) Photograph of the gross specimen shows a regular, white-yellow mass containing focal areas of necrosis and hemorrhage. Scale is in millimeters.
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Figure 16b. Intercostal schwannoma in a 72-year-old woman with a known area of increased opaci-ty in the left upper lobe. (a) Contrast-enhanced CT scan shows a well-defined, heterogeneous solid mass attached to the thoracic wall. (b) Photograph of the gross specimen shows a regular, white-yellow mass containing focal areas of necrosis and hemorrhage. Scale is in millimeters.
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Figure 17a. Neurofibroma in a 43-year-old man with known neurofibromatosis who presented with a large axillary mass and a 3-month history of right arm pain. (a) Contrast-enhanced CT scan with coronal two-dimensional reconstruction demonstrates a well-defined mass with central necrosis displacing the right subclavian artery. (b) Sagittal T2-weighted fast spin-echo MR image shows a regular mass with a high-signal-intensity area of necrosis.
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Figure 17b. Neurofibroma in a 43-year-old man with known neurofibromatosis who presented with a large axillary mass and a 3-month history of right arm pain. (a) Contrast-enhanced CT scan with coronal two-dimensional reconstruction demonstrates a well-defined mass with central necrosis displacing the right subclavian artery. (b) Sagittal T2-weighted fast spin-echo MR image shows a regular mass with a high-signal-intensity area of necrosis.
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Figure 18a. Hemangioma in a 33-year-old man with a slow-growing thoracic wall mass of 20 years duration. (a) Contrast-enhanced CT scan demonstrates complex nodular masses with phleboliths in the chest wall (arrowheads). (b) Coronal T1-weighted MR image shows multiple low-signal-intensity masses deforming the lower chest wall (arrowheads). (c) On an axial T2-weighted MR image, the extremely high-signal-intensity hemangiomas can be clearly differentiated from adjacent chest wall structures.
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Figure 18b. Hemangioma in a 33-year-old man with a slow-growing thoracic wall mass of 20 years duration. (a) Contrast-enhanced CT scan demonstrates complex nodular masses with phleboliths in the chest wall (arrowheads). (b) Coronal T1-weighted MR image shows multiple low-signal-intensity masses deforming the lower chest wall (arrowheads). (c) On an axial T2-weighted MR image, the extremely high-signal-intensity hemangiomas can be clearly differentiated from adjacent chest wall structures.
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Figure 18c. Hemangioma in a 33-year-old man with a slow-growing thoracic wall mass of 20 years duration. (a) Contrast-enhanced CT scan demonstrates complex nodular masses with phleboliths in the chest wall (arrowheads). (b) Coronal T1-weighted MR image shows multiple low-signal-intensity masses deforming the lower chest wall (arrowheads). (c) On an axial T2-weighted MR image, the extremely high-signal-intensity hemangiomas can be clearly differentiated from adjacent chest wall structures.
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Figure 19a. Desmoid tumor in a 53-year-old woman with a parasternal mass. (a) CT scan demonstrates a homogeneous soft-tissue mass of the parasternum without adjacent bone destruction. (b) Photograph of a cut specimen shows a firm, whitish mass with an irregularly whorled surface. Scale is in centimeters. (c) Axial short-inversion-time inversion recovery MR image obtained 2 years after surgery reveals the recurrence of two high-signal-intensity masses in the anterior chest wall and axillary region (arrows).
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Figure 19b. Desmoid tumor in a 53-year-old woman with a parasternal mass. (a) CT scan demonstrates a homogeneous soft-tissue mass of the parasternum without adjacent bone destruction. (b) Photograph of a cut specimen shows a firm, whitish mass with an irregularly whorled surface. Scale is in centimeters. (c) Axial short-inversion-time inversion recovery MR image obtained 2 years after surgery reveals the recurrence of two high-signal-intensity masses in the anterior chest wall and axillary region (arrows).
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Figure 19c. Desmoid tumor in a 53-year-old woman with a parasternal mass. (a) CT scan demonstrates a homogeneous soft-tissue mass of the parasternum without adjacent bone destruction. (b) Photograph of a cut specimen shows a firm, whitish mass with an irregularly whorled surface. Scale is in centimeters. (c) Axial short-inversion-time inversion recovery MR image obtained 2 years after surgery reveals the recurrence of two high-signal-intensity masses in the anterior chest wall and axillary region (arrows).
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Figure 20a. Hemangiopericytoma in an 82-year-old woman with a 2-month history of severe resting dyspnea. (a) Posteroanterior chest radiograph shows a large area of increased opacity in the right hemithorax mimicking an elevated diaphragm. (b) CT scan obtained with the patient in the lateral decubitus position reveals a large, heterogeneous solid mass with pleural effusion. The 2.1-kg mass was resected with a portion of the chest wall. Hemangiopericytoma was diagnosed at histologic analysis.
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Figure 20b. Hemangiopericytoma in an 82-year-old woman with a 2-month history of severe resting dyspnea. (a) Posteroanterior chest radiograph shows a large area of increased opacity in the right hemithorax mimicking an elevated diaphragm. (b) CT scan obtained with the patient in the lateral decubitus position reveals a large, heterogeneous solid mass with pleural effusion. The 2.1-kg mass was resected with a portion of the chest wall. Hemangiopericytoma was diagnosed at histologic analysis.
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Figure 21. Lymphoma in a 62-year-old man with a lower thoracic wall mass and a 3-month history of vague discomfort. Contrast-enhanced CT scan demonstrates diffuse thickening of the left thoracic wall and diaphragm (arrowheads).
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Figure 22a. Rhabdomyosarcoma in a 23-year-old woman who presented with a mass below the right breast that had been growing rapidly since she gave birth 2 months earlier. (a) Contrast-enhanced CT scan demonstrates a heterogeneous mass in the chest wall behind the breast. (b) Coronal T1-weighted MR image shows the well-defined mass as nearly isointense relative to muscle. (c) Axial T2-weighted spin-echo MR image shows the homogeneous high-signal-intensity mass.
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Figure 22b. Rhabdomyosarcoma in a 23-year-old woman who presented with a mass below the right breast that had been growing rapidly since she gave birth 2 months earlier. (a) Contrast-enhanced CT scan demonstrates a heterogeneous mass in the chest wall behind the breast. (b) Coronal T1-weighted MR image shows the well-defined mass as nearly isointense relative to muscle. (c) Axial T2-weighted spin-echo MR image shows the homogeneous high-signal-intensity mass.
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Figure 22c. Rhabdomyosarcoma in a 23-year-old woman who presented with a mass below the right breast that had been growing rapidly since she gave birth 2 months earlier. (a) Contrast-enhanced CT scan demonstrates a heterogeneous mass in the chest wall behind the breast. (b) Coronal T1-weighted MR image shows the well-defined mass as nearly isointense relative to muscle. (c) Axial T2-weighted spin-echo MR image shows the homogeneous high-signal-intensity mass.
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Figure 23a. Fibrous dysplasia in a 36-year-old man with a chest wall mass. (a) Chest radiograph reveals expansion and distortion of the left third rib (arrow). (b) Thin-section CT scan shows a multiloculated, sharply marginated, expanding lytic area surrounded by a thin cortex. (c) Radiograph of the resected specimen demonstrates lytic areas with a characteristic hazy, ground-glass appearance.
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Figure 23b. Fibrous dysplasia in a 36-year-old man with a chest wall mass. (a) Chest radiograph reveals expansion and distortion of the left third rib (arrow). (b) Thin-section CT scan shows a multiloculated, sharply marginated, expanding lytic area surrounded by a thin cortex. (c) Radiograph of the resected specimen demonstrates lytic areas with a characteristic hazy, ground-glass appearance.
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Figure 23c. Fibrous dysplasia in a 36-year-old man with a chest wall mass. (a) Chest radiograph reveals expansion and distortion of the left third rib (arrow). (b) Thin-section CT scan shows a multiloculated, sharply marginated, expanding lytic area surrounded by a thin cortex. (c) Radiograph of the resected specimen demonstrates lytic areas with a characteristic hazy, ground-glass appearance.
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Figure 24a. Rib plasmacytoma in a 50-year-old man with a mass of the chest wall and left iliac crest. (a) Posteroanterior chest radiograph shows a large mass protruding into the thorax along the lower axillary lung zone with a destructive rib lesion. (b) Photograph of a cut specimen of the rib shows the soft, expansile, crumbled hemorrhagic mass with yellowish necrotic areas (arrows). Scale is in centimeters.
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Figure 24b. Rib plasmacytoma in a 50-year-old man with a mass of the chest wall and left iliac crest. (a) Posteroanterior chest radiograph shows a large mass protruding into the thorax along the lower axillary lung zone with a destructive rib lesion. (b) Photograph of a cut specimen of the rib shows the soft, expansile, crumbled hemorrhagic mass with yellowish necrotic areas (arrows). Scale is in centimeters.
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Figure 25a. Rib chondrosarcoma in a 27-year-old woman with a rapidly growing thoracic wall mass of 2 months duration. (a) Chest radiograph demonstrates a calcified mass of the third rib. (b) CT scan shows the well-circumscribed, 6-cm-diameter, calcified mass. (c) T1-weighted MR image shows the low-signal-intensity mass containing a focal area of hemorrhage. (d) Short-inversion-time inversion recovery MR image demonstrates low-signal-intensity areas of calcification within the high-signal-intensity mass.
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Figure 25b. Rib chondrosarcoma in a 27-year-old woman with a rapidly growing thoracic wall mass of 2 months duration. (a) Chest radiograph demonstrates a calcified mass of the third rib. (b) CT scan shows the well-circumscribed, 6-cm-diameter, calcified mass. (c) T1-weighted MR image shows the low-signal-intensity mass containing a focal area of hemorrhage. (d) Short-inversion-time inversion recovery MR image demonstrates low-signal-intensity areas of calcification within the high-signal-intensity mass.
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Figure 25c. Rib chondrosarcoma in a 27-year-old woman with a rapidly growing thoracic wall mass of 2 months duration. (a) Chest radiograph demonstrates a calcified mass of the third rib. (b) CT scan shows the well-circumscribed, 6-cm-diameter, calcified mass. (c) T1-weighted MR image shows the low-signal-intensity mass containing a focal area of hemorrhage. (d) Short-inversion-time inversion recovery MR image demonstrates low-signal-intensity areas of calcification within the high-signal-intensity mass.
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Figure 25d. Rib chondrosarcoma in a 27-year-old woman with a rapidly growing thoracic wall mass of 2 months duration. (a) Chest radiograph demonstrates a calcified mass of the third rib. (b) CT scan shows the well-circumscribed, 6-cm-diameter, calcified mass. (c) T1-weighted MR image shows the low-signal-intensity mass containing a focal area of hemorrhage. (d) Short-inversion-time inversion recovery MR image demonstrates low-signal-intensity areas of calcification within the high-signal-intensity mass.
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Figure 26a. Parosteal osteosarcoma in a 34-year-old man who complained of recent onset of pain in the scar region from a resection of the ninth rib that he had undergone 10 years earlier for bone tumor. (a) CT scan reveals a regular, hyperattenuating mass within the eighth rib. (b) Radiograph of the gross specimen shows the densely ossifying lesion superior to the thickened inner cortex and separated from the cortex by radiolucent soft tissue. (c) Photograph of a cut specimen demonstrates the compact bone tumor surrounded by peritumoral fibrous tissue that extends to the periosteum of the eighth rib.
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Figure 26b. Parosteal osteosarcoma in a 34-year-old man who complained of recent onset of pain in the scar region from a resection of the ninth rib that he had undergone 10 years earlier for bone tumor. (a) CT scan reveals a regular, hyperattenuating mass within the eighth rib. (b) Radiograph of the gross specimen shows the densely ossifying lesion superior to the thickened inner cortex and separated from the cortex by radiolucent soft tissue. (c) Photograph of a cut specimen demonstrates the compact bone tumor surrounded by peritumoral fibrous tissue that extends to the periosteum of the eighth rib.
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Figure 26c. Parosteal osteosarcoma in a 34-year-old man who complained of recent onset of pain in the scar region from a resection of the ninth rib that he had undergone 10 years earlier for bone tumor. (a) CT scan reveals a regular, hyperattenuating mass within the eighth rib. (b) Radiograph of the gross specimen shows the densely ossifying lesion superior to the thickened inner cortex and separated from the cortex by radiolucent soft tissue. (c) Photograph of a cut specimen demonstrates the compact bone tumor surrounded by peritumoral fibrous tissue that extends to the periosteum of the eighth rib.
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Copyright © 1999 by the Radiological Society of North America.
