Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Localized fibrous tumor of the pleura
- Radiologic Findings
- Chest PA shows a huge mass in left hemithorax with obliteration of left cardiac border.
CT scans show markedly increased size of the mass occupying left hemithorax, compared with CT scans about two years ago. The mass involves mediastinal fat, pericardium and pleura, but does not extend to lung or chest wall. Pericardial and pleural effusions are associated.
Localizaed (or solitary) fibrous tumor of pleura was diagnosed via percutaneous transthoracic needle biopsy.
two years ago
current CT with coronal reformation
- Brief Review
- Localized fibrous tumor (LFT) of the pleura was formerly known as benign mesothelioma, but it is not mesothelial in origin and not necessarily benign. Approximately 30% of these tumors are malignant, although they have a good prognosis. It is unassociated with asbestos exposure.
LFT is usually detected incidentally on chest radiographs. However, it can be associated with hypoglycemia (5% of cases) due to production of insulin-like growth factor type 2 (IGF-2), hypertrophic pulmonary osteoarthropathy (one third of cases), or chest pain. The symptoms resolve with resection.
LFT arises from the visceral pleura in 70%. It typically appears as a solitary, smooth, sharply defined, often large lesion, contacting a pleural surface. When small, LFT tends to have obtuse angles at the pleural surface; when large, the angles are usually acute. LFT can be seen within a fissure, mimicking the appearance of loculated fluid. A “beak” or “thorn” sign is often visible on plain radiographs in patients with an LFT originating in or projecting into a fissure. They may also arise on a stalk and move with change in patient position. Pleural effusion is not usually present.
On CT, even if acute angles are visible, slight pleural thickening is usually visible adjacent to the mass. This thickening may reflect a small amount of fluid accumulating in the pleural space at the point where the visceral and parietal pleural surfaces area separated by the tumor. Masses may appear homogeneous. Necrosis can result in a multicystic appearance with or without contrast infusion. Large arteries supplying the mass may be seen. Calcification may be present.
- References
- 1. W. Richard Webb. The mediastinum: mediastinal masses. Thoracic imaging. 2nd ed. Lippincott Williams & Wilkins 2011: 646~647
- Keywords
- Pleura, Benign tumor,